Healthcare Provider Details

I. General information

NPI: 1114121555
Provider Name (Legal Business Name): TIFFANY BRYANT OSBORNE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VISION DR
ASHEBORO NC
27203-3855
US

IV. Provider business mailing address

4000 ARDSLEY CT
GREENSBORO NC
27407-7869
US

V. Phone/Fax

Practice location:
  • Phone: 336-672-5450
  • Fax:
Mailing address:
  • Phone: 336-202-6349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: