Provider Demographics
NPI:1053653303
Name:TUNGET, ROBERTA JOSEPHINE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JOSEPHINE
Last Name:TUNGET
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:JOSEPHINE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1300 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2947
Mailing Address - Country:US
Mailing Address - Phone:618-534-1860
Mailing Address - Fax:
Practice Address - Street 1:1300 N STATE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2947
Practice Address - Country:US
Practice Address - Phone:618-534-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist