Provider Demographics
NPI:1417673518
Name:BEENE, TIFFANY RACHEL (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RACHEL
Last Name:BEENE
Suffix:
Gender:F
Credentials:MS,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 362
Mailing Address - Street 2:
Mailing Address - City:FORT COBB
Mailing Address - State:OK
Mailing Address - Zip Code:73038-0362
Mailing Address - Country:US
Mailing Address - Phone:405-693-5665
Mailing Address - Fax:
Practice Address - Street 1:709 N EAST ST
Practice Address - Street 2:
Practice Address - City:FORT COBB
Practice Address - State:OK
Practice Address - Zip Code:73038-2403
Practice Address - Country:US
Practice Address - Phone:405-693-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist