Provider Demographics
NPI:1700279940
Name:TAJOURI, TONYA JEANENE (CRT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:JEANENE
Last Name:TAJOURI
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2831
Mailing Address - Country:US
Mailing Address - Phone:618-410-4620
Mailing Address - Fax:
Practice Address - Street 1:8012 GODFREY RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2831
Practice Address - Country:US
Practice Address - Phone:618-410-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010008030227800000X
IL194005194227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified