Healthcare Provider Details

I. General information

NPI: 1083802425
Provider Name (Legal Business Name): TONYA LYNN BUCZKOWSKI M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 ANDY CIR
EAGLE RIVER AK
99577-8577
US

IV. Provider business mailing address

PO BOX 770913
EAGLE RIVER AK
99577-0913
US

V. Phone/Fax

Practice location:
  • Phone: 907-694-4806
  • Fax:
Mailing address:
  • Phone: 907-694-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number87
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: