Provider Demographics
NPI:1053558155
Name:GONZALEZ, CHERYL A I (BS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:GONZALEZ
Suffix:I
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:SHAWNEE
Other - Middle Name:A
Other - Last Name:NEUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:4929 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2324
Mailing Address - Country:US
Mailing Address - Phone:414-871-6122
Mailing Address - Fax:414-871-2552
Practice Address - Street 1:4929 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2324
Practice Address - Country:US
Practice Address - Phone:414-871-6122
Practice Address - Fax:414-871-2552
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator