Provider Demographics
NPI:1760092233
Name:TOWNSEND, TIFFANY ALEXANDRIA (CPM, CLC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ALEXANDRIA
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:CPM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WORDEN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1351
Mailing Address - Country:US
Mailing Address - Phone:616-375-1727
Mailing Address - Fax:
Practice Address - Street 1:1000 WORDEN ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1351
Practice Address - Country:US
Practice Address - Phone:616-375-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
MI176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty