Provider Demographics
NPI:1336452879
Name:SCOTT, TONYA RENEE (CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15937 LECLAIRE AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3970
Mailing Address - Country:US
Mailing Address - Phone:630-200-3077
Mailing Address - Fax:
Practice Address - Street 1:2 OLYMPUS DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4827
Practice Address - Country:US
Practice Address - Phone:708-614-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist