Provider Demographics
NPI:1922132992
Name:HARRISON, TIFFANY (SLP, MA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:SLP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 ROOSEVELT ST STE K
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3022
Mailing Address - Country:US
Mailing Address - Phone:619-846-3588
Mailing Address - Fax:619-923-2918
Practice Address - Street 1:3138 ROOSEVELT ST STE K
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3022
Practice Address - Country:US
Practice Address - Phone:619-846-3588
Practice Address - Fax:619-923-2918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891235222OtherGROUP NPI