Provider Demographics
NPI:1306887799
Name:JURGENSEN, TONIANN M (THERAPIST)
Entity type:Individual
Prefix:
First Name:TONIANN
Middle Name:M
Last Name:JURGENSEN
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10219 NE 31ST PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1931
Mailing Address - Country:US
Mailing Address - Phone:415-889-2690
Mailing Address - Fax:
Practice Address - Street 1:2445 140TH AVE NE
Practice Address - Street 2:SUITE B105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1879
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:425-644-6295
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist