Provider Demographics
NPI:1124405006
Name:HAAN, TIFFANY (MS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HAAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:TROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 N CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1548
Mailing Address - Country:US
Mailing Address - Phone:815-474-6382
Mailing Address - Fax:
Practice Address - Street 1:400 N MORROW ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1496
Practice Address - Country:US
Practice Address - Phone:815-844-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist