Healthcare Provider Details

I. General information

NPI: 1750286829
Provider Name (Legal Business Name): TIFFANY J SCOTT LANDINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 W BELOIT RD STE 201
MILWAUKEE WI
53227-4357
US

IV. Provider business mailing address

7503 W CONGRESS ST
MILWAUKEE WI
53218-5447
US

V. Phone/Fax

Practice location:
  • Phone: 414-755-2677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9359226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: