Provider Demographics
NPI:1932541323
Name:ROSS, TIFFANY R
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1945
Mailing Address - Country:US
Mailing Address - Phone:417-326-5291
Mailing Address - Fax:417-326-3562
Practice Address - Street 1:524 W MADISON ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1945
Practice Address - Country:US
Practice Address - Phone:417-326-5291
Practice Address - Fax:417-326-3562
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013020972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist