MEDICARE: MRS. TIFFANY BRIDIS INDIERO MS, 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	102483	TX

General Provider Information

NPI Number	:	1942393285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY BRIDIS INDIERO MS, CCC/SLP

Provider Business Mailing Address
First Line	:	16807 GENTLE STONE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5120
Country	:	US
Telephone Number	:	281-859-2269
Fax Number	:

Provider Business Practice Location Address
First Line	:	10804 HUFFMEISTER RD
Second Line	:	SUITE D
City	:	HOUSTON
State	:	TX
Zip	:	77065-3177
Country	:	US
Telephone Number	:	281-477-9500
Fax Number	:	281-477-9563

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	07/08/2007

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