Provider Demographics
NPI:1235548108
Name:VAN SICKLE, TIFFANY LEE ANN (BS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE ANN
Last Name:VAN SICKLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LEE ANN
Other - Last Name:SHERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0867
Mailing Address - Country:US
Mailing Address - Phone:435-637-7200
Mailing Address - Fax:435-637-2377
Practice Address - Street 1:198 E CENTER ST.
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532
Practice Address - Country:US
Practice Address - Phone:435-259-6131
Practice Address - Fax:435-259-5369
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator