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General NPI Number Information
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NPI Number | 1710849203
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Entity Type | Individual
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Provider Name | TIFFANY VAN DEE
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 860 17TH ST SE
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-2610
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Country | US
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Telephone | 319-250-4429
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Fax |
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Provider Business Mailing Address
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Address Line | 304 W WASHINGTON ST
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City | MARENGO
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State | IA
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Zip | 52301-1235
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Country | US
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Telephone | 319-529-2588
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Fax | 319-529-2588
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T25085
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License Number State | IA
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