Provider Demographics
NPI:1639462633
Name:ROBERTS HINER, TIFFANY BROOKE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:BROOKE
Last Name:ROBERTS HINER
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 1:2105 S 22ND CT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1737
Mailing Address - Country:US
Mailing Address - Phone:405-880-0817
Mailing Address - Fax:
Practice Address - Street 1:814 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4225
Practice Address - Country:US
Practice Address - Phone:405-377-8255
Practice Address - Fax:405-377-8255
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist