Provider Demographics
NPI:1659042588
Name:GONZALES, ADINA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18551 E 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-8519
Mailing Address - Country:US
Mailing Address - Phone:303-655-5158
Mailing Address - Fax:
Practice Address - Street 1:18551 E 160TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-8519
Practice Address - Country:US
Practice Address - Phone:303-655-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108376235Z00000X
CO0005349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist