Provider Demographics
NPI:1760213276
Name:MCCUSKER, TIFFANY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 SW REGENCY PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7753
Mailing Address - Country:US
Mailing Address - Phone:479-252-3321
Mailing Address - Fax:
Practice Address - Street 1:3201 SW REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7469
Practice Address - Country:US
Practice Address - Phone:479-252-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist