Individual
TIFFANY ANN SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1955 STATE ROUTE 146 E, ANNA, IL 62906-3501
(618) 833-4774
Mailing address
650 OTTEN LN, ANNA, IL 62906-3091
(618) 528-0273
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
12043627
IL
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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