Provider Demographics
NPI:1336576883
Name:MONIZ, TIFFANY M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:MONIZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 COOL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-6128
Mailing Address - Country:US
Mailing Address - Phone:570-777-5373
Mailing Address - Fax:
Practice Address - Street 1:215 COOL CREEK WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-6128
Practice Address - Country:US
Practice Address - Phone:717-685-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007168235Z00000X
PASL013163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty