Provider Demographics
NPI:1982828125
Name:TOSH, MYRA ELAINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:ELAINE
Last Name:TOSH
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:PO BOX 19662
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9662
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-0253
Practice Address - Street 1:720 N BOND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4952
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-0253
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist