MEDICARE: ALLISON MARIE GONZALEZ MS, CCC-SLP

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	SLP-2361	WV

General Provider Information

NPI Number	:	1710732912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MARIE GONZALEZ MS, CCC-SLP

Provider Business Mailing Address
First Line	:	4403 STONEWOOD DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-3896
Country	:	US
Telephone Number	:	847-331-3625
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 LAKEVIEW DR STE 2C
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-9326
Country	:	US
Telephone Number	:	304-406-6162
Fax Number	:

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

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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