Provider Demographics
NPI:1093835365
Name:TOMCHAK, MARY LOU (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:TOMCHAK
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Mailing Address - Street 1:2250 MISSOURI AVE
Mailing Address - Street 2:#6G
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5172
Mailing Address - Country:US
Mailing Address - Phone:505-522-1231
Mailing Address - Fax:505-523-1108
Practice Address - Street 1:780 S WALNUT ST
Practice Address - Street 2:BLDG #7
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1425
Practice Address - Country:US
Practice Address - Phone:505-526-1161
Practice Address - Fax:505-523-1108
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist