Provider Demographics
NPI:1629406822
Name:SACOMANI, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SACOMANI
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 1:17706 I-30
Mailing Address - Street 2:STE. 3
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2907
Mailing Address - Country:US
Mailing Address - Phone:501-315-4414
Mailing Address - Fax:
Practice Address - Street 1:17706 I-30
Practice Address - Street 2:STE. 3
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2907
Practice Address - Country:US
Practice Address - Phone:501-315-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist