Provider Demographics
NPI:1598800674
Name:WHITE, TIFFANY ANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WATERWAY CT APT 3D
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-4443
Mailing Address - Country:US
Mailing Address - Phone:410-610-1137
Mailing Address - Fax:
Practice Address - Street 1:1001 FLEET ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4346
Practice Address - Country:US
Practice Address - Phone:800-627-4276
Practice Address - Fax:410-843-8441
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04891OtherDHMH LICENSE