Healthcare Provider Details

I. General information

NPI: 1881056745
Provider Name (Legal Business Name): TIFFANY ANNE WALTZ BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 01/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 BILLINGSLEY RD
COLUMBUS OH
43235-1990
US

IV. Provider business mailing address

6486 REFLECTIONS DR APT. C
DUBLIN OH
43017-2333
US

V. Phone/Fax

Practice location:
  • Phone: 614-407-6508
  • Fax:
Mailing address:
  • Phone: 614-584-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number243
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: