Provider Demographics
NPI:1316010754
Name:TONKIN, SUSAN G
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:TONKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:TONKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3946 E GRAYTHORN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6632
Mailing Address - Country:US
Mailing Address - Phone:480-704-5410
Mailing Address - Fax:
Practice Address - Street 1:3900 S MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-7005
Practice Address - Country:US
Practice Address - Phone:480-497-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ589666Medicaid