Provider Demographics
NPI:1609157916
Name:GONZALES, LUCINDA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:MARIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LUCINDA
Other - Middle Name:
Other - Last Name:BRODEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UCONN MEDICAL GROUP
Mailing Address - Street 2:850 BOLTON ROAD, U-85
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269
Mailing Address - Country:US
Mailing Address - Phone:860-486-2629
Mailing Address - Fax:
Practice Address - Street 1:214 MERIGOLD DR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1447
Practice Address - Country:US
Practice Address - Phone:203-376-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist