MEDICARE: MS. MARTHA CECILIA GONZALEZ SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0152891	NY

General Provider Information

NPI Number	:	1013160084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA CECILIA GONZALEZ SLP

Provider Business Mailing Address
First Line	:	2775 E 12TH ST APT 126
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4641
Country	:	US
Telephone Number	:	718-934-5626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 E 12TH ST APT 126
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4641
Country	:	US
Telephone Number	:	718-934-5626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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Directions to “ MS. MARTHA CECILIA GONZALEZ SLP” Practice Location

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