Provider Demographics
NPI:1477350429
Name:PEREZ, TIFFANI (CF-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:PEREZ
Suffix:
Gender:
Credentials:CF-SLP
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 223
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MO
Mailing Address - Zip Code:65338-0223
Mailing Address - Country:US
Mailing Address - Phone:623-703-4919
Mailing Address - Fax:
Practice Address - Street 1:20363 LANE OF CHAMPIONS
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-6463
Practice Address - Country:US
Practice Address - Phone:660-438-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024043533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist