MEDICARE: MS. TIFFANY ANN WHITE CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	04891	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04891	OTHER	MD	DHMH LICENSE

General Provider Information

NPI Number	:	1598800674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY ANN WHITE CCC-SLP

Provider Business Mailing Address
First Line	:	6 WATERWAY CT APT 3D
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-4443
Country	:	US
Telephone Number	:	410-610-1137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 FLEET ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4346
Country	:	US
Telephone Number	:	800-627-4276
Fax Number	:	410-843-8441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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Directions to “ MS. TIFFANY ANN WHITE CCC-SLP” Practice Location

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