1518030303 NPI number — MRS. TONYA SHONDELL RUSH MS CF SLP

Table of content: MRS. TONYA SHONDELL RUSH MS CF SLP (NPI 1518030303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518030303 NPI number — MRS. TONYA SHONDELL RUSH MS CF SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSH
Provider First Name:
TONYA
Provider Middle Name:
SHONDELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CF SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518030303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5545 STATE HIGHWAY 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALISTER
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-458-6611
Provider Business Mailing Address Fax Number:
505-458-6611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 NORTH CHURCH STREET
Provider Second Line Business Practice Location Address:
ELIDA MUNICIPAL SCHOOL
Provider Business Practice Location Address City Name:
ELIDA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-274-6211
Provider Business Practice Location Address Fax Number:
505-274-6213
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  C4003 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com