Provider Demographics
NPI:1154532158
Name:SKILLERN, TIFFANY STAR (MACCCSLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:STAR
Last Name:SKILLERN
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 CHIPPENDALE ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2927
Mailing Address - Country:US
Mailing Address - Phone:567-303-8364
Mailing Address - Fax:
Practice Address - Street 1:2909 CHIPPENDALE ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2927
Practice Address - Country:US
Practice Address - Phone:234-348-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 8781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist