Provider Demographics
NPI:1033236864
Name:TOUTONGHI, MARY JEAN (SPEECHLANGUAGEPATH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEAN
Last Name:TOUTONGHI
Suffix:
Gender:F
Credentials:SPEECHLANGUAGEPATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2244
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2244
Mailing Address - Country:US
Mailing Address - Phone:907-262-4886
Mailing Address - Fax:907-262-4889
Practice Address - Street 1:43977 STERLING HWY
Practice Address - Street 2:SUITE H
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8028
Practice Address - Country:US
Practice Address - Phone:907-262-4886
Practice Address - Fax:907-262-4889
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK20235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP2449Medicaid