Provider Demographics
NPI:1437656949
Name:MACDONALD, TONYA JILL (MSED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:JILL
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6205
Mailing Address - Country:US
Mailing Address - Phone:808-779-8849
Mailing Address - Fax:
Practice Address - Street 1:3532 KINGS GRANT RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4531
Practice Address - Country:US
Practice Address - Phone:757-648-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist