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Individual

TIFANIE LYN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS

Contact information

Practice address
316 E 8TH ST, OKMULGEE, OK 74447-4616
(918) 758-2000
Mailing address
9410 N 96TH EAST AVE, OWASSO, OK 74055-7279
(918) 510-1116

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3914
OK

Other

Enumeration date
06/08/2012
Last updated
01/14/2021
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