Provider Demographics
NPI:1659955615
Name:PLATKO, TIFFANY L
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:PLATKO
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 1:29077 CLEMENS RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1135
Mailing Address - Country:US
Mailing Address - Phone:440-871-9735
Mailing Address - Fax:
Practice Address - Street 1:1820 GRANTWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4004
Practice Address - Country:US
Practice Address - Phone:440-506-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician