Provider Demographics
NPI:1649632977
Name:QUAIL, TIFFANY (IADC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:QUAIL
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:515-574-6138
Mailing Address - Fax:515-573-7898
Practice Address - Street 1:720 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5759
Practice Address - Country:US
Practice Address - Phone:515-574-6138
Practice Address - Fax:515-573-7898
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16046171M00000X
IA18009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator