Individual
TIFFANY BANYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1901 MISSION 66, SUITE A, VICKSBURG, MS 39180-3711
(601) 638-4076
(601) 638-4979
Mailing address
PO BOX 822394, VICKSBURG, MS 39182-2394
(601) 638-4076
(601) 638-4979
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2928
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05274351
—
MS
Enumeration date
01/05/2007
Last updated
07/08/2007
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