Provider Demographics
NPI:1568231355
Name:WALSH, TIFFINI DE
Entity Type:Individual
Prefix:MS
First Name:TIFFINI
Middle Name:DE
Last Name:WALSH
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 1:1533 44TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3110
Mailing Address - Country:US
Mailing Address - Phone:970-397-5148
Mailing Address - Fax:
Practice Address - Street 1:3000 W 13TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6304
Practice Address - Country:US
Practice Address - Phone:970-348-2200
Practice Address - Fax:970-348-2230
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO229862235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist