Provider Demographics
NPI:1518030303
Name:RUSH, TONYA SHONDELL (MS CF SLP)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:SHONDELL
Last Name:RUSH
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
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Mailing Address - Street 1:5545 STATE HIGHWAY 209
Mailing Address - Street 2:
Mailing Address - City:MCALISTER
Mailing Address - State:NM
Mailing Address - Zip Code:88427
Mailing Address - Country:US
Mailing Address - Phone:505-458-6611
Mailing Address - Fax:505-458-6611
Practice Address - Street 1:103 NORTH CHURCH STREET
Practice Address - Street 2:ELIDA MUNICIPAL SCHOOL
Practice Address - City:ELIDA
Practice Address - State:NM
Practice Address - Zip Code:88116
Practice Address - Country:US
Practice Address - Phone:505-274-6211
Practice Address - Fax:505-274-6213
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMC4003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist