MEDICARE: MRS. TIFFANY RACHEL BEENE M.S.,CCC-SLP

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	3878	OK

General Provider Information

NPI Number	:	1417673518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY RACHEL BEENE M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 362
Second Line	:
City	:	FORT COBB
State	:	OK
Zip	:	73038-0362
Country	:	US
Telephone Number	:	405-693-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 N EAST ST
Second Line	:
City	:	FORT COBB
State	:	OK
Zip	:	73038-2403
Country	:	US
Telephone Number	:	405-693-5665
Fax Number	:

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

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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Directions to “ MRS. TIFFANY RACHEL BEENE M.S.,CCC-SLP” Practice Location

Language	Start Address	Practice Location

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