Provider Demographics
NPI:1750866075
Name:KITTILSTVED, TIFFANI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:KITTILSTVED
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22443 SE 240TH ST STE B101
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5879
Mailing Address - Country:US
Mailing Address - Phone:425-358-7160
Mailing Address - Fax:
Practice Address - Street 1:22443 SE 240TH ST STE B101
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5879
Practice Address - Country:US
Practice Address - Phone:425-358-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60861871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist