Provider Demographics
NPI:1144465527
Name:WITTY, TIFFANY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNN
Last Name:WITTY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:15420 MILL CREEK BLVD
Mailing Address - Street 2:APT. S104
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1735
Mailing Address - Country:US
Mailing Address - Phone:425-286-3664
Mailing Address - Fax:206-729-9032
Practice Address - Street 1:9100 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2861
Practice Address - Country:US
Practice Address - Phone:206-526-2662
Practice Address - Fax:206-729-9032
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALL 00004462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL 00004462OtherWA STATE DEPARTMENT OF HEALTH
WA12105283OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION