Provider Demographics
NPI:1548483217
Name:WAYS, TIFFANY LEE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LEE
Last Name:WAYS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1641 WESTCHESTER BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7115
Mailing Address - Country:US
Mailing Address - Phone:419-720-3213
Mailing Address - Fax:
Practice Address - Street 1:730 E VINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2553
Practice Address - Country:US
Practice Address - Phone:217-528-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700237104100000X
IL1490135681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149013568OtherSTATE OF ILLINOIS DIVISION OF PROFESSIONAL REGULATIONS
OHS0700237OtherLSW