Provider Demographics
NPI:1538883533
Name:MCDUFFEY-TOWNSEND, VONTIJA
Entity type:Individual
Prefix:
First Name:VONTIJA
Middle Name:
Last Name:MCDUFFEY-TOWNSEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 HAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2256
Mailing Address - Country:US
Mailing Address - Phone:419-279-4460
Mailing Address - Fax:
Practice Address - Street 1:5660 SOUTHWYCK BLVD STE 108
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1597
Practice Address - Country:US
Practice Address - Phone:419-279-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care