Provider Demographics
NPI:1629139480
Name:SIMPSON, TIFFANY CHEYANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHEYANNE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:CHEYANNE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:8725 SCANDINAVIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-1744
Mailing Address - Country:US
Mailing Address - Phone:816-518-0034
Mailing Address - Fax:
Practice Address - Street 1:8725 SCANDINAVIA BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-1744
Practice Address - Country:US
Practice Address - Phone:816-518-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115987235Z00000X
GASLP010508235Z00000X
CA30971235Z00000X
FLSA20950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist