Provider Demographics
NPI:1811091176
Name:SCHRADER, TONYA KAY (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:KAY
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LEWIS AVE S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-4500
Mailing Address - Country:US
Mailing Address - Phone:952-955-3323
Mailing Address - Fax:952-255-8075
Practice Address - Street 1:204 LEWIS AVE S
Practice Address - Street 2:SUITE 104
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-4500
Practice Address - Country:US
Practice Address - Phone:952-955-3323
Practice Address - Fax:952-255-8075
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46-01122OtherMEDICA
MNC08611048584OtherPREFERRED ONE
MN030N8SCOtherBCBS