MEDICARE: TIFFANY SUE THURMAN

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	103K00000X	Behavior Analyst	095916	IA

General Provider Information

NPI Number	:	1376037390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY SUE THURMAN

Provider Business Mailing Address
First Line	:	5374 EASTERN AVE STE 600
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2720
Country	:	US
Telephone Number	:	920-857-9041
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 N DODGE ST STE A
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-9558
Country	:	US
Telephone Number	:	319-379-0032
Fax Number	:

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

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	10/18/2022

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Directions to “ TIFFANY SUE THURMAN ” Practice Location

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