Provider Demographics
NPI:1407689904
Name:VOTAVA, TONI (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:VOTAVA
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 COOPER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1512
Mailing Address - Country:US
Mailing Address - Phone:701-352-2574
Mailing Address - Fax:701-352-0188
Practice Address - Street 1:516 COOPER AVE STE 102
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1512
Practice Address - Country:US
Practice Address - Phone:701-352-2574
Practice Address - Fax:701-352-0188
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND417824103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool