Provider Demographics
NPI:1609140326
Name:GONZALEZ, JENNIFER S (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3253
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063-3253
Mailing Address - Country:US
Mailing Address - Phone:775-830-8874
Mailing Address - Fax:
Practice Address - Street 1:1205 19TH AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9189
Practice Address - Country:US
Practice Address - Phone:253-517-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2024-01-19
Deactivation Date:2018-06-23
Deactivation Code:
Reactivation Date:2024-01-19
Provider Licenses
StateLicense IDTaxonomies
NV09148767235Z00000X
NVSP-778235Z00000X
WA60388930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist