Doctor Name: | TIFANIE LYN |
NPI Number: | 1164784831 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | 3914 |
Business Practice Address: | 12899 E 76th St N Ste. 109 Owasso, OK - 740554021 |
Business Phone Number: | 9186096003 |
Business Fax Number: | 9186096002 |
Mailing Address: | 12899 E 76th St N, Ste. 109 OWASSO |
State: | OK |
Postal Code: | 740554021 |
Phone Number: | 9186096003 |
Fax Number: | 9186096002 |
NPI Enumeration Date: | 06/08/2012 |
NPI Last Update Date: | 06/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3914 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
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 |