Provider Demographics
NPI:1467191619
Name:WERDERMAN, TIFFANY ANNE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANNE
Last Name:WERDERMAN
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 1:318 WILEY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-3516
Mailing Address - Country:US
Mailing Address - Phone:319-310-7589
Mailing Address - Fax:
Practice Address - Street 1:3412 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5529
Practice Address - Country:US
Practice Address - Phone:319-382-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist