Provider Demographics
NPI:1851975056
Name:GONZALEZ-RANDOLPH, AUSTIN (LP)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:GONZALEZ-RANDOLPH
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HOWARD ST STE R
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:425-780-5094
Mailing Address - Fax:
Practice Address - Street 1:214 MAPLE ST UNIT B
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4425
Practice Address - Country:US
Practice Address - Phone:425-780-5094
Practice Address - Fax:425-537-6473
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61278527103T00000X
WI4078-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist