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General NPI Number Information
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NPI Number | 1497308324
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Entity Type | Individual
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Provider Name | ODLENE GONZALEZ M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 12030 SW 129TH CT STE 209
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City | MIAMI
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State | FL
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Zip | 33186-4584
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Country | US
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Telephone | 786-429-3619
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Fax |
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Provider Business Mailing Address
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Address Line | 8848 SW 222ND TER
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City | CUTLER BAY
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State | FL
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Zip | 33190-1250
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Country | US
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Telephone | 786-266-7545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SZ9302
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA18277
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License Number State | FL
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