Provider Demographics
NPI:1629350699
Name:WEST, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WEST
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 1:2040 E 32ND ST
Mailing Address - Street 2:RM 114
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3107
Mailing Address - Country:US
Mailing Address - Phone:410-235-4801
Mailing Address - Fax:410-235-6535
Practice Address - Street 1:2040 E 32ND ST
Practice Address - Street 2:RM 114
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3107
Practice Address - Country:US
Practice Address - Phone:410-235-4801
Practice Address - Fax:410-235-6535
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0008A2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant