Provider Demographics
NPI:1487368213
Name:ALLRED, TIFFANIE ANNE (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:ANNE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:UT
Mailing Address - Zip Code:84001-0353
Mailing Address - Country:US
Mailing Address - Phone:435-749-9458
Mailing Address - Fax:
Practice Address - Street 1:1010 E 200 N
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-2585
Practice Address - Country:US
Practice Address - Phone:435-725-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9280387-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist