Provider Demographics
NPI:1962447276
Name:DETRAGLIA-VANNOSTRAND, TONI M (SLP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:DETRAGLIA-VANNOSTRAND
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9430
Mailing Address - Country:US
Mailing Address - Phone:315-253-0361
Mailing Address - Fax:315-255-2158
Practice Address - Street 1:CAYUGA-ONONDAGA BOCES
Practice Address - Street 2:1879 WEST GENESEE ST. ROAD
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1811
Practice Address - Country:US
Practice Address - Phone:315-253-0361
Practice Address - Fax:315-255-2158
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist