Provider Demographics
NPI:1225394851
Name:TONKOVICH, JOHN D (PHD, CCC-SLP/A)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:TONKOVICH
Suffix:
Gender:M
Credentials:PHD, CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46191 WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5615
Mailing Address - Country:US
Mailing Address - Phone:586-883-0734
Mailing Address - Fax:
Practice Address - Street 1:4641 OLD CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1550
Practice Address - Country:US
Practice Address - Phone:407-892-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ASHA 00393298235Z00000X
FLSA15053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty