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General NPI Number Information
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NPI Number | 1851975056
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Entity Type | Individual
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Provider Name | AUSTIN GONZALEZ-RANDOLPH LP
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Gender | Male
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 712 MONROE AVE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-2126
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Country | US
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Telephone | 425-780-5094
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Fax | 425-537-6473
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Provider Business Mailing Address
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Address Line | 100 N HOWARD ST STE R
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City | SPOKANE
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State | WA
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Zip | 99201-0508
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Country | US
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Telephone | 425-780-5094
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4078-57
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY61278527
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License Number State | WA
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