Provider Demographics
NPI:1649578311
Name:HERNANDEZ, TONYA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials: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 1:898 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2627
Mailing Address - Country:US
Mailing Address - Phone:541-881-7330
Mailing Address - Fax:541-881-7334
Practice Address - Street 1:898 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2627
Practice Address - Country:US
Practice Address - Phone:541-881-7330
Practice Address - Fax:541-881-7334
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP 1807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist