Provider Demographics
NPI:1770817561
Name:GONZALEZ, ANGELA (SLP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:REUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:100 DIPLOMAT DR
Mailing Address - Street 2:#5H
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2004
Mailing Address - Country:US
Mailing Address - Phone:914-218-8774
Mailing Address - Fax:
Practice Address - Street 1:100 DIPLOMAT DR
Practice Address - Street 2:#5H
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2004
Practice Address - Country:US
Practice Address - Phone:914-218-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011401-1235Z00000X
NY011401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03799391Medicaid