Provider Demographics
NPI:1093837593
Name:TOLLEFSON, MITTIE ANNA (BC-HIS)
Entity Type:Individual
Prefix:MS
First Name:MITTIE
Middle Name:ANNA
Last Name:TOLLEFSON
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:100 VERDE VALLEY SCHOOL RD
Practice Address - Street 2:STE 105
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-9053
Practice Address - Country:US
Practice Address - Phone:928-284-5200
Practice Address - Fax:928-284-5201
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4365237700000X
CAHT8070237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist