Provider Demographics
NPI:1578871562
Name:GONZALEZ, ANGELA MARIA (SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 BOULEVARD E
Mailing Address - Street 2:APT 2D
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5972
Mailing Address - Country:US
Mailing Address - Phone:201-838-8841
Mailing Address - Fax:
Practice Address - Street 1:7300 BOULEVARD E
Practice Address - Street 2:APT 2D
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5972
Practice Address - Country:US
Practice Address - Phone:201-838-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist