Provider Demographics
NPI:1053550111
Name:PHELPS, TIFFANY VERNON (CCC/SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:VERNON
Last Name:PHELPS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 HEARTLAND WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8867
Mailing Address - Country:US
Mailing Address - Phone:540-809-8010
Mailing Address - Fax:540-891-1622
Practice Address - Street 1:4610 HEARTLAND WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-8867
Practice Address - Country:US
Practice Address - Phone:540-809-8010
Practice Address - Fax:540-891-1622
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist