Provider Demographics
NPI:1538160346
Name:JOHNSON, TONDALAO DELEE (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:TONDALAO
Middle Name:DELEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3923
Mailing Address - Country:US
Mailing Address - Phone:970-593-9137
Mailing Address - Fax:970-593-0232
Practice Address - Street 1:909 E EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3923
Practice Address - Country:US
Practice Address - Phone:970-593-9137
Practice Address - Fax:970-593-9137
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO267231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5502AP00151000OtherBLUE CROSS
CO481018Medicare ID - Type Unspecified