Provider Demographics
NPI:1285418178
Name:TONKOVIC, NICOLE MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:TONKOVIC
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1260
Mailing Address - Country:US
Mailing Address - Phone:314-718-1997
Mailing Address - Fax:
Practice Address - Street 1:126 N PAYNE ST
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1260
Practice Address - Country:US
Practice Address - Phone:314-718-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021028461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist