Provider Demographics
NPI:1871214445
Name:GONZALEZ, ALEXANDRA (LSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3086
Mailing Address - Country:US
Mailing Address - Phone:847-834-9844
Mailing Address - Fax:
Practice Address - Street 1:444 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3086
Practice Address - Country:US
Practice Address - Phone:847-834-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150107438104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker