Provider Demographics
NPI:1942718218
Name:TONYAN, SUZANNE BERNADETTE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BERNADETTE
Last Name:TONYAN
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 1:10108 BUTTON RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IL
Mailing Address - Zip Code:60034-8868
Mailing Address - Country:US
Mailing Address - Phone:815-354-0806
Mailing Address - Fax:
Practice Address - Street 1:300 S DRIFTWOOD TRL
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5456
Practice Address - Country:US
Practice Address - Phone:815-344-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty