Individual
MS. TIFFANI LYN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
1642 WARHAWK RD, PERU, IN 46970-8737
(765) 689-9363
Mailing address
1642 WARHAWK RD, PERU, IN 46970-8737
(765) 689-9363
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22003751A
IN
Other
Enumeration date
07/12/2009
Last updated
07/12/2009
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