Provider Demographics
NPI:1487841516
Name:EMERSON, TIFFANY J (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:J
Last Name:EMERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:J
Other - Last Name:JOLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:187 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1024
Mailing Address - Country:US
Mailing Address - Phone:978-957-4884
Mailing Address - Fax:
Practice Address - Street 1:40 PARKHURST RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1513
Practice Address - Country:US
Practice Address - Phone:978-256-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist