Provider Demographics
NPI:1174722375
Name:LEACH-BERTH, TIFFANY S (AUD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:S
Last Name:LEACH-BERTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:S
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:512-607-4893
Practice Address - Street 1:2001 LINCOLN DR W
Practice Address - Street 2:SUITE E
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1531
Practice Address - Country:US
Practice Address - Phone:856-596-9670
Practice Address - Fax:856-985-6302
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00073000231H00000X
NJ237700000X
NJYA730,MG949237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ115350ZDHSOtherMEDICARE