Provider Demographics
NPI:1033247002
Name:ST GERMAIN, TIFFANY J (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:J
Last Name:ST GERMAIN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:J
Other - Last Name:FERRAZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:UNIT B9
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7244
Practice Address - Country:US
Practice Address - Phone:401-849-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00148231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist