Provider Demographics
NPI:1457565475
Name:TONEY, HERMON III (CSA)
Entity Type:Individual
Prefix:
First Name:HERMON
Middle Name:
Last Name:TONEY
Suffix:III
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6937 S CONSTANCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1507
Mailing Address - Country:US
Mailing Address - Phone:312-925-3260
Mailing Address - Fax:
Practice Address - Street 1:6937 S CONSTANCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1507
Practice Address - Country:US
Practice Address - Phone:312-925-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL238000006OtherSTATE LICENSE