Provider Demographics
NPI:1164822854
Name:JANICEK, TONYA (HIS)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:
Last Name:JANICEK
Suffix:
Gender:F
Credentials:HIS
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 1464
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-1464
Mailing Address - Country:US
Mailing Address - Phone:281-789-4874
Mailing Address - Fax:
Practice Address - Street 1:19221 I H 45 S STE 140
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8731
Practice Address - Country:US
Practice Address - Phone:281-363-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80634237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist