Provider Demographics
NPI:1760651863
Name:SOMERVILLE-PHILPOTTS, TOLANDA (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TOLANDA
Middle Name:
Last Name:SOMERVILLE-PHILPOTTS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7034
Mailing Address - Country:US
Mailing Address - Phone:219-750-9600
Mailing Address - Fax:219-370-0096
Practice Address - Street 1:8690 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7034
Practice Address - Country:US
Practice Address - Phone:219-750-9600
Practice Address - Fax:219-370-0096
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003978A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200679910OtherMEDICAID/FIRST STEPS
IN200462650Medicaid