Provider Demographics
NPI:1376037390
Name:THURMAN, TIFFANY SUE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SUE
Last Name:THURMAN
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 1:5374 EASTERN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2720
Mailing Address - Country:US
Mailing Address - Phone:920-857-9041
Mailing Address - Fax:
Practice Address - Street 1:2545 N DODGE ST STE A
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9558
Practice Address - Country:US
Practice Address - Phone:319-379-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095916103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst