Provider Demographics
NPI:1205724978
Name:GONZALEZ, MYKALEA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MYKALEA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MYKALEA
Other - Middle Name:
Other - Last Name:DYCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:5378 N GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5060
Mailing Address - Country:US
Mailing Address - Phone:414-430-9309
Mailing Address - Fax:
Practice Address - Street 1:5378 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5060
Practice Address - Country:US
Practice Address - Phone:414-430-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14416375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty