Provider Demographics
NPI:1922556745
Name:ZILKA, TIFFANY
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:ZILKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5034
Mailing Address - Country:US
Mailing Address - Phone:605-394-4036
Mailing Address - Fax:605-394-5119
Practice Address - Street 1:300 6TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5034
Practice Address - Country:US
Practice Address - Phone:605-394-4036
Practice Address - Fax:605-394-5119
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD79693-0103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool