Provider Demographics
NPI:1124151543
Name:NETTLES, TIFFANY CHERE' (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:CHERE'
Last Name:NETTLES
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3027
Mailing Address - Country:US
Mailing Address - Phone:202-265-6679
Mailing Address - Fax:
Practice Address - Street 1:525 BRYANT ST NW
Practice Address - Street 2:ROOM 139Y
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-1005
Practice Address - Country:US
Practice Address - Phone:202-806-6991
Practice Address - Fax:202-387-1327
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist