Provider Demographics
NPI:1447081831
Name:GONZALEZ, JEAN C (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BARNHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-0077
Mailing Address - Country:US
Mailing Address - Phone:787-607-0211
Mailing Address - Fax:
Practice Address - Street 1:103 N PLAIN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6760
Practice Address - Country:US
Practice Address - Phone:910-298-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist