Individual
MRS. TIFFANY LOUISE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 E MAIN ST STE 1, WILLOW SPRINGS, MO 65793-1423
(417) 883-6761
Mailing address
5444 HIGHWAY 17, EUNICE, MO 65468-6807
(417) 217-9297
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-99976
MO
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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