Provider Demographics
NPI:1720391618
Name:ROSALES, AMALIA GONZALEZ (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMALIA
Middle Name:GONZALEZ
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:AMALIA
Other - Middle Name:JASMIN
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:760 C ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023
Mailing Address - Country:US
Mailing Address - Phone:559-304-0664
Mailing Address - Fax:
Practice Address - Street 1:662 HAZEL DELL RD
Practice Address - Street 2:
Practice Address - City:CORRALITOS
Practice Address - State:CA
Practice Address - Zip Code:95076-0313
Practice Address - Country:US
Practice Address - Phone:831-755-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist