MEDICARE: TIFFANI WADLEY CSW

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	1041C0700X	Clinical Social Worker	CSW09931454	CO
2	1041C0700X	Clinical Social Worker	14237716-3501	UT
3	1041C0700X	Clinical Social Worker	24779	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1295448413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI WADLEY CSW

Provider Business Mailing Address
First Line	:	1635 E HIGHWAY 50 STE 206
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5035
Country	:	US
Telephone Number	:	720-476-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 E HIGHWAY 50 STE 206
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5035
Country	:	US
Telephone Number	:	720-476-1252
Fax Number	:

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

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/29/2026

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Directions to “ TIFFANI WADLEY CSW” Practice Location

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