MEDICARE: STEPHANIE MARIE GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA23155	FL

General Provider Information

NPI Number	:	1669937652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE GONZALEZ

Provider Business Mailing Address
First Line	:	6996 W 25TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5459
Country	:	US
Telephone Number	:	786-521-9501
Fax Number	:

Provider Business Practice Location Address
First Line	:	9399 NW 121ST TER
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4225
Country	:	US
Telephone Number	:	786-412-3162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	01/12/2026

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