Provider Demographics
NPI:1689711707
Name:GONZALEZ, SARA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3431
Mailing Address - Country:US
Mailing Address - Phone:651-340-4372
Mailing Address - Fax:
Practice Address - Street 1:METHODIST HOSPITAL
Practice Address - Street 2:6500 EXCELSIOR BLVD
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:651-340-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist