Provider Demographics
NPI:1760641005
Name:EDMOND, TONJA RENEE (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:RENEE
Last Name:EDMOND
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MEMORIAL DR STE D4D5
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2700
Mailing Address - Country:US
Mailing Address - Phone:404-289-4270
Mailing Address - Fax:
Practice Address - Street 1:3300 MEMORIAL DR STE D4D5
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2700
Practice Address - Country:US
Practice Address - Phone:404-289-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist