Provider Demographics
NPI:1184686578
Name:SULLIVAN, TIFFANY
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070
Mailing Address - Country:US
Mailing Address - Phone:405-307-2814
Mailing Address - Fax:405-307-2801
Practice Address - Street 1:2002 E ROBINSON
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:AR
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-307-2814
Practice Address - Fax:405-307-2801
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist