Provider Demographics
NPI:1558898429
Name:SWANSON, TIFFANY MICHELE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MICHELE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:MICHELE
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 BROADWAY ST NE STE 403
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1420
Mailing Address - Country:US
Mailing Address - Phone:503-363-8068
Mailing Address - Fax:503-390-3161
Practice Address - Street 1:1300 BROADWAY ST NE STE 403
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1420
Practice Address - Country:US
Practice Address - Phone:503-363-8068
Practice Address - Fax:503-390-3161
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist