Healthcare Provider Details

I. General information

NPI: 1265865513
Provider Name (Legal Business Name): TONIA MUTIAT LCKRAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TONIA CLAYE

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 EAST AVE STE J
NORWALK CT
06851-4903
US

IV. Provider business mailing address

4 MAPLEWOOD RD
HARTSDALE NY
10530-1625
US

V. Phone/Fax

Practice location:
  • Phone: 203-293-7672
  • Fax: 914-470-6200
Mailing address:
  • Phone: 914-328-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number023083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: