Provider Demographics
NPI:1497043145
Name:VALERA, TIFFANY ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:VALERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:420 14TH ST
Mailing Address - Street 2:APARTMENT 8
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2342
Mailing Address - Country:US
Mailing Address - Phone:415-312-6030
Mailing Address - Fax:
Practice Address - Street 1:420 14TH ST
Practice Address - Street 2:APARTMENT 8
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2342
Practice Address - Country:US
Practice Address - Phone:415-312-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14180OtherSPEECH PATHOLOGY STATE LICENSE