Provider Demographics
NPI:1114230265
Name:BOWER, TIFFANY (CCSS)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 IRWIN ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5269
Mailing Address - Country:US
Mailing Address - Phone:505-453-6464
Mailing Address - Fax:505-843-8449
Practice Address - Street 1:8121 IRWIN ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5269
Practice Address - Country:US
Practice Address - Phone:505-453-6464
Practice Address - Fax:505-843-8449
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker