Provider Demographics
NPI:1700131232
Name:STRODTHOFF, TIFFANY L (MS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:STRODTHOFF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W MILWAUKEE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2998
Mailing Address - Country:US
Mailing Address - Phone:608-755-1475
Mailing Address - Fax:
Practice Address - Street 1:15 W MILWAUKEE ST STE 207
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2998
Practice Address - Country:US
Practice Address - Phone:608-755-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1451-226101YP2500X
WI280-228106H00000X
WI15715-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)