Provider Demographics
NPI:1326412164
Name:HINES, TIFFANY DEANNA (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:DEANNA
Last Name:HINES
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
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 100547
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-0547
Mailing Address - Country:US
Mailing Address - Phone:843-661-1123
Mailing Address - Fax:
Practice Address - Street 1:201 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3427
Practice Address - Country:US
Practice Address - Phone:843-661-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist