Healthcare Provider Details

I. General information

NPI: 1407763378
Provider Name (Legal Business Name): DALIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 S 4TH ST
MILWAUKEE WI
53204-1724
US

IV. Provider business mailing address

3708 E MARTIN AVE
CUDAHY WI
53110-1910
US

V. Phone/Fax

Practice location:
  • Phone: 414-902-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001028761
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: