Provider Demographics
NPI:1013160084
Name:GONZALEZ, MARTHA CECILIA (SLP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:CECILIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 E 12TH ST APT 126
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4641
Mailing Address - Country:US
Mailing Address - Phone:718-934-5626
Mailing Address - Fax:
Practice Address - Street 1:2775 E 12TH ST APT 126
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4641
Practice Address - Country:US
Practice Address - Phone:718-934-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0152891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist