Basic Information
| Provider Information | |||||||||
| NPI: | 1053838276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSKEY | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DOLLAR | ||||||||
| OtherFirstName: | TIFFANY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003288602 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1202 S JAMES CAMPBELL BLVD, SUITE 15 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317973147 | ||||||||
| FaxNumber: | 9319131215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | TN | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | 0000000806 | TN | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.