Provider Demographics
NPI:1164864096
Name:CALDWELL, TONYA ANN
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:ANN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16828 ELLIS AVE.
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60478
Mailing Address - Country:US
Mailing Address - Phone:708-217-0984
Mailing Address - Fax:
Practice Address - Street 1:593 HICKORY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3961
Practice Address - Country:US
Practice Address - Phone:708-217-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist