Healthcare Provider Details

I. General information

NPI: 1134295306
Provider Name (Legal Business Name): TIFFANY MARIE HUIZENGA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KNAPP ST
CHETEK WI
54728-9107
US

IV. Provider business mailing address

1001 KNAPP ST
CHETEK WI
54728-9107
US

V. Phone/Fax

Practice location:
  • Phone: 715-924-2226
  • Fax: 715-924-2376
Mailing address:
  • Phone: 715-924-2226
  • Fax: 715-924-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12089004
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberC3990
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: