Provider Demographics
NPI:1083337919
Name:CLAIRMORE, TIFFANY ANN (SAC-IT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANN
Last Name:CLAIRMORE
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC-IT
Mailing Address - Street 1:210 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5543
Mailing Address - Country:US
Mailing Address - Phone:715-845-3637
Mailing Address - Fax:
Practice Address - Street 1:210 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5543
Practice Address - Country:US
Practice Address - Phone:715-845-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19791-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)