Provider Demographics
NPI:1700474517
Name:BYNUM, TIFFANY GRAY (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GRAY
Last Name:BYNUM
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:NICOLE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 ALDERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-3174
Mailing Address - Country:US
Mailing Address - Phone:864-752-8558
Mailing Address - Fax:
Practice Address - Street 1:343 PRADO WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6512
Practice Address - Country:US
Practice Address - Phone:864-270-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist