MEDICARE: TIFFANY SLATER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP010548	GA

General Provider Information

NPI Number	:	1205554060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY SLATER

Provider Business Mailing Address
First Line	:	2801 KINGSRIDGE DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-3734
Country	:	US
Telephone Number	:	706-580-2648
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 KINGSRIDGE DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-3734
Country	:	US
Telephone Number	:	706-580-2648
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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Directions to “ TIFFANY SLATER ” Practice Location

Language	Start Address	Practice Location

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