Provider Demographics
NPI:1902005945
Name:GRAHAM, TIFFINI LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFINI
Middle Name:LYNN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:TIFFINI
Other - Middle Name:LYNN
Other - Last Name:BITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:540 S PARKER ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3593
Mailing Address - Country:US
Mailing Address - Phone:810-765-8110
Mailing Address - Fax:810-765-9811
Practice Address - Street 1:23575 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-3108
Practice Address - Country:US
Practice Address - Phone:586-791-2470
Practice Address - Fax:586-792-7668
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12051242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist