Provider Demographics
NPI:1669804225
Name:GONZALEZ, CAROLYN (BS - SPEECH THERAPY)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BS - SPEECH THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CALLE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-2220
Mailing Address - Country:US
Mailing Address - Phone:939-940-2574
Mailing Address - Fax:
Practice Address - Street 1:60 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-2220
Practice Address - Country:US
Practice Address - Phone:939-940-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant