Healthcare Provider Details

I. General information

NPI: 1720237779
Provider Name (Legal Business Name): TIFFANY J LUMPKINS MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RAINBOW BLVD
EXCELSIOR SPRINGS MO
64024
US

IV. Provider business mailing address

2008 KARLTON WAY
EXCELSIOR SPRINGS MO
64024-1694
US

V. Phone/Fax

Practice location:
  • Phone: 816-630-6081
  • Fax:
Mailing address:
  • Phone: 816-516-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: