Provider Demographics
NPI:1255408126
Name:BUSSELL, TONYA ANN (MS CCC SLP SPEECH PA)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:ANN
Last Name:BUSSELL
Suffix:
Gender:F
Credentials:MS CCC SLP SPEECH PA
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 STEVEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-6307
Mailing Address - Country:US
Mailing Address - Phone:405-214-6526
Mailing Address - Fax:
Practice Address - Street 1:127 STEVEN DRIVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-6307
Practice Address - Country:US
Practice Address - Phone:405-401-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12005431OtherASHA