Provider Demographics
NPI:1902018658
Name:GONZALEZ, ZULMA NOEMI (MACCCSLP)
Entity Type:Individual
Prefix:MS
First Name:ZULMA
Middle Name:NOEMI
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 DERBYSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3120
Mailing Address - Country:US
Mailing Address - Phone:407-572-2364
Mailing Address - Fax:
Practice Address - Street 1:820 CYPRESS PKWY STE B
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3424
Practice Address - Country:US
Practice Address - Phone:407-913-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10618235Z00000X
FLSA 10618222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003289400Medicaid