Provider Demographics
NPI:1063237931
Name:GONZALEZ, ANGELICA SOPHIA (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:SOPHIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 218TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2611
Mailing Address - Country:US
Mailing Address - Phone:347-844-2420
Mailing Address - Fax:
Practice Address - Street 1:2075 E 68TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6455
Practice Address - Country:US
Practice Address - Phone:718-968-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist