Provider Demographics
NPI:1902270135
Name:TRUESDELL, TONIA MARIA (PHD)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:MARIA
Last Name:TRUESDELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:MARIA
Other - Last Name:WOLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:102 W WASHINGTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4368
Mailing Address - Country:US
Mailing Address - Phone:906-228-8881
Mailing Address - Fax:906-228-4549
Practice Address - Street 1:118 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSE
Practice Address - State:MI
Practice Address - Zip Code:49946
Practice Address - Country:US
Practice Address - Phone:906-228-8881
Practice Address - Fax:906-228-4549
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014354103TC0700X
MI6301016559103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling