Provider Demographics
NPI:1720572738
Name:BARRICKLOW, TIFFANY RAE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:BARRICKLOW
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 1:12041 RAVENNA RD # 12041
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-7008
Mailing Address - Country:US
Mailing Address - Phone:440-286-7154
Mailing Address - Fax:
Practice Address - Street 1:12041 RAVENNA RD # 12041
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7008
Practice Address - Country:US
Practice Address - Phone:440-286-7154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator