Healthcare Provider Details

I. General information

NPI: 1750512653
Provider Name (Legal Business Name): TIFFANY COLLEEN ADAMS M.S.-SLP/CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY COLLEEN PETERSON

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MAPLE DR
STE GENEVIEVE MO
63670-1141
US

IV. Provider business mailing address

1453 GLENDA DR
FARMINGTON MO
63640-7763
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-4500
  • Fax:
Mailing address:
  • Phone: 573-430-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2999
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6625
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: