=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538098660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH GONZALEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2026
-----------------------------------------------------
Last Update Date | 05/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1243 W LINCOLN AVE
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53074-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-268-5750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 544 FIRST ST
-----------------------------------------------------
City | BELGIUM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53004-9306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-698-2190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1001370487
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------