Provider Demographics
NPI:1083802425
Name:BUCZKOWSKI, TONYA LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNN
Last Name:BUCZKOWSKI
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 770913
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0913
Mailing Address - Country:US
Mailing Address - Phone:907-694-4806
Mailing Address - Fax:
Practice Address - Street 1:9001 ANDY CIR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8577
Practice Address - Country:US
Practice Address - Phone:907-694-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK87235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP6561Medicaid