Provider Demographics
NPI:1376842369
Name:TONDRAVI, MEENA THERESA (MED, MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEENA
Middle Name:THERESA
Last Name:TONDRAVI
Suffix:
Gender:F
Credentials:MED, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MARILYN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2834
Mailing Address - Country:US
Mailing Address - Phone:425-750-5686
Mailing Address - Fax:
Practice Address - Street 1:6 MARILYN RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-2834
Practice Address - Country:US
Practice Address - Phone:425-750-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist