Provider Demographics
NPI:1588308597
Name:GONZALEZ, ALEJANDRO (MS)
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 E STATE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2158
Mailing Address - Country:US
Mailing Address - Phone:815-708-9068
Mailing Address - Fax:
Practice Address - Street 1:4615 E STATE ST STE 204
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2158
Practice Address - Country:US
Practice Address - Phone:815-708-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health