Provider Demographics
NPI:1184161705
Name:CASEY, TIFFANY (SLP-A)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0739
Mailing Address - Country:US
Mailing Address - Phone:870-580-3601
Mailing Address - Fax:870-368-4920
Practice Address - Street 1:99 HALEY ST.
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-0739
Practice Address - Country:US
Practice Address - Phone:870-580-3601
Practice Address - Fax:870-368-4920
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant