| Doctor Name: | MRS. TIFFANY CHRISTINA THACKER |
| NPI Number: | 1003981911 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | SA 7450 |
| Business Practice Address: | 3898 Via Poinciana Lake Worth, FL - 334672951 |
| Business Phone Number: | 5619669273 |
| Business Fax Number: | 5613668810 |
| Mailing Address: | 5710 Dewberry Way, Xxxx WEST PALM BEACH |
| State: | FL |
| Postal Code: | 334154570 |
| Phone Number: | 5613138243 |
| Fax Number: | |
| NPI Enumeration Date: | 11/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA 7450 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |