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General NPI Number Information
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NPI Number | 1568197770
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Entity Type | Individual
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Provider Name | KAREN MONIQUE GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9801 W VAN BUREN ST
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City | TOLLESON
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State | AZ
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Zip | 85353-2833
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Country | US
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Telephone | 623-474-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 11620 W ENCANTO BLVD
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City | AVONDALE
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State | AZ
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Zip | 85392-5117
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Country | US
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Telephone | 562-440-2493
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA13897
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License Number State | AZ
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