Provider Demographics
NPI:1952046161
Name:TIFFANY TALIAFERRO SPEECH PATHOLOGIST LLC
Entity Type:Organization
Organization Name:TIFFANY TALIAFERRO SPEECH PATHOLOGIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST-SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:JONAY
Authorized Official - Last Name:TALIAFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:410-805-7068
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20830-1360
Mailing Address - Country:US
Mailing Address - Phone:301-774-0052
Mailing Address - Fax:301-774-8535
Practice Address - Street 1:3423 OLNEY LAYTONSVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-3707
Practice Address - Country:US
Practice Address - Phone:301-774-0052
Practice Address - Fax:301-774-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1861169526OtherINDEPENDENT CONTRACTOR