Provider Demographics
NPI:1598010936
Name:LYON, TIFFANY D (MS CCC - SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:LYON
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 1:729 AREPEEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108
Mailing Address - Country:US
Mailing Address - Phone:801-581-4956
Mailing Address - Fax:301-654-7175
Practice Address - Street 1:729 AREPEEN DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-581-4956
Practice Address - Fax:301-654-7175
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist