Provider Demographics
NPI:1427284090
Name:WONG-TRUFANOFF, LONNIE (MA)
Entity type:Individual
Prefix:MS
First Name:LONNIE
Middle Name:
Last Name:WONG-TRUFANOFF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2343
Mailing Address - Country:US
Mailing Address - Phone:845-691-2251
Mailing Address - Fax:845-462-2731
Practice Address - Street 1:143 BOARDMAN RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-4870
Practice Address - Country:US
Practice Address - Phone:845-462-6701
Practice Address - Fax:845-462-2731
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58003141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist