Provider Demographics
NPI:1205138039
Name:TIEFENBRUNN, MIRIAM (SLP)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:TIEFENBRUNN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:KOZLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 SHOLOM CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4966
Mailing Address - Country:US
Mailing Address - Phone:718-285-9831
Mailing Address - Fax:
Practice Address - Street 1:1312 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3612
Practice Address - Country:US
Practice Address - Phone:718-686-3700
Practice Address - Fax:718-686-2395
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist