Healthcare Provider Details

I. General information

NPI: 1992420806
Provider Name (Legal Business Name): SAMANTHA JEAN GONZALEZ M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 MCQUEEN SMITH RD N STE H
PRATTVILLE AL
36066-7559
US

IV. Provider business mailing address

2753 PONY CLUB LN
COLORADO SPRINGS CO
80922-3289
US

V. Phone/Fax

Practice location:
  • Phone: 334-350-3362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: