Provider Demographics
NPI:1710060363
Name:CHARKO, TIFFANY ANN (MA CCC SLP)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:ANN
Last Name:CHARKO
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTH VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01002
Mailing Address - Country:US
Mailing Address - Phone:413-256-2632
Mailing Address - Fax:
Practice Address - Street 1:ONE ROUNDHOUSE PLAZA
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTHHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-586-1945
Practice Address - Fax:413-586-1946
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist