Provider Demographics
NPI:1164931499
Name:ALEXANDER, BREONA GONZALEZ (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BREONA
Middle Name:GONZALEZ
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 LIGHTHOUSE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2666
Mailing Address - Country:US
Mailing Address - Phone:831-318-0558
Mailing Address - Fax:
Practice Address - Street 1:667 LIGHTHOUSE AVE STE 201
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2666
Practice Address - Country:US
Practice Address - Phone:831-318-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37544235Z00000X
SC6296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty