Basic Information
| Provider Information | |||||||||
| NPI: | 1417270893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RINDT | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherLastName: | HILGART | ||||||||
| OtherFirstName: | TIFFANY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1119 N WISCONSIN ST | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530741209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622845892 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1119 N WISCONSIN ST | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530741209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622845892 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2010 | ||||||||
| LastUpdateDate: | 03/12/2010 | ||||||||
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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 | 235Z00000X | 3331154 | WI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.