Provider Demographics
NPI:1902509250
Name:SAW, TIFFANY S (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:SAW
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 FARALLONES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2939
Mailing Address - Country:US
Mailing Address - Phone:415-309-2899
Mailing Address - Fax:
Practice Address - Street 1:4722 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-4443
Practice Address - Country:US
Practice Address - Phone:415-309-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist