Individual
TIFFINY BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2101 S 42ND ST, OMAHA, NE 68105-2909
(402) 553-3000
Mailing address
58 CHARLES ST, COUNCIL BLUFFS, IA 51503-4959
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11561
NE
Other
Enumeration date
07/27/2021
Last updated
08/05/2021
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