Provider Demographics
NPI:1932320504
Name:NEWBERRY, TIFFANY JILL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JILL
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:MA, 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:MASON COUNTY BOE
Mailing Address - Street 2:2001 MCCOY ROAD
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-0000
Mailing Address - Country:US
Mailing Address - Phone:304-675-1260
Mailing Address - Fax:
Practice Address - Street 1:MASON COUNTY BOE
Practice Address - Street 2:2001 MCCOY ROAD
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-0000
Practice Address - Country:US
Practice Address - Phone:304-675-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist