Provider Demographics
NPI:1619131950
Name:WAGAR, TIFFANY A (AUD)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:A
Last Name:WAGAR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WADSWORTH RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9504
Mailing Address - Country:US
Mailing Address - Phone:330-336-8717
Mailing Address - Fax:330-335-0092
Practice Address - Street 1:195 WADSWORTH RD
Practice Address - Street 2:SUITE 401
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9504
Practice Address - Country:US
Practice Address - Phone:330-336-8717
Practice Address - Fax:330-335-0092
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01614231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000214717OtherUNISON
OH11779561OtherCAQH
OH$$$$$$$$$001OtherMEDICAL MUTUAL