Provider Demographics
NPI:1659985091
Name:NELSON, TIFFANY (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15255 S 94TH AVE # 508
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3800
Mailing Address - Country:US
Mailing Address - Phone:708-770-0814
Mailing Address - Fax:
Practice Address - Street 1:15255 S 94TH AVE # 508
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3800
Practice Address - Country:US
Practice Address - Phone:708-770-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty