Provider Demographics
NPI:1023342201
Name:GONZALEZ, AMBER (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
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 1:105 WOODS LANDING TRAIL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677
Mailing Address - Country:US
Mailing Address - Phone:727-510-2248
Mailing Address - Fax:
Practice Address - Street 1:105 WOODS LANDING TRAIL
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677
Practice Address - Country:US
Practice Address - Phone:727-510-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888004200Medicaid