Provider Demographics
NPI:1679619563
Name:CARSON, TONYA LORENE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LORENE
Last Name:CARSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:CARSON
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12812 KEDDLESTONE LANE
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:407-491-3825
Mailing Address - Fax:407-905-8958
Practice Address - Street 1:886 SOUTH DILLARD ST.
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3910
Practice Address - Country:US
Practice Address - Phone:407-905-8958
Practice Address - Fax:407-905-8958
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8883866Medicaid