Provider Demographics
NPI:1659648293
Name:PATOUNAS, TIFFANY KRUGGER (MA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:KRUGGER
Last Name:PATOUNAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2319
Mailing Address - Country:US
Mailing Address - Phone:518-451-9591
Mailing Address - Fax:
Practice Address - Street 1:42 LONGMEADOW DR
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2319
Practice Address - Country:US
Practice Address - Phone:518-451-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015133-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist