Provider Demographics
NPI:1700897790
Name:GONZALEZ, ALICIA CHRISTINE (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:CHRISTINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BLACKHORSE HILL RD
Mailing Address - Street 2:PM & R (117A)
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2040
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:610-380-4327
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:610-380-4327
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005995231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist