Provider Demographics
NPI:1306057922
Name:TOMENKO, RHONDA M (PHD)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:M
Last Name:TOMENKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 N. MAIN STREET BLDG. 9
Mailing Address - Street 2:MAIL UNIT 10
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9681
Mailing Address - Country:US
Mailing Address - Phone:574-247-6047
Mailing Address - Fax:574-247-6060
Practice Address - Street 1:6910 N MAIN ST UNIT 9
Practice Address - Street 2:MAIL UNIT 10
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9681
Practice Address - Country:US
Practice Address - Phone:574-247-6047
Practice Address - Fax:574-247-6060
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002350A237600000X
MI1601000577237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200499770Medicaid