Provider Demographics
NPI:1891050613
Name:BEAUDRY, TIFFANY ELIZABETH (MSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 PALMER ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4628
Mailing Address - Country:US
Mailing Address - Phone:616-437-6595
Mailing Address - Fax:616-710-5176
Practice Address - Street 1:152 PALMER ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4628
Practice Address - Country:US
Practice Address - Phone:616-437-6595
Practice Address - Fax:616-710-5176
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010930421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical