Provider Demographics
NPI:1922145135
Name:O'CONNOR TRIANA, TIFFANY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:O'CONNOR TRIANA
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 1:4130 S CORDIA CT
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218
Mailing Address - Country:US
Mailing Address - Phone:602-402-3025
Mailing Address - Fax:480-982-7080
Practice Address - Street 1:1000 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232
Practice Address - Country:US
Practice Address - Phone:520-866-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ616790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ616790Medicaid