Provider Demographics
NPI:1740730100
Name:ACKERMAN, TONYA LEIGH (BSW)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LEIGH
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 3 1/2 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:MI
Mailing Address - Zip Code:49011
Mailing Address - Country:US
Mailing Address - Phone:269-317-0431
Mailing Address - Fax:
Practice Address - Street 1:677 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032-8524
Practice Address - Country:US
Practice Address - Phone:269-467-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker