Provider Demographics
NPI:1407091549
Name:SUPINSKI, TIFFANY ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:SUPINSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANNE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 MINER FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12921-3003
Mailing Address - Country:US
Mailing Address - Phone:518-846-7135
Mailing Address - Fax:518-846-8322
Practice Address - Street 1:185 MARGARET ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1837
Practice Address - Country:US
Practice Address - Phone:518-561-6361
Practice Address - Fax:518-561-6367
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist