Provider Demographics
NPI:1194920645
Name:TIREY, LIBBY (BC-HIS)
Entity type:Individual
Prefix:MRS
First Name:LIBBY
Middle Name:
Last Name:TIREY
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-5310
Mailing Address - Country:US
Mailing Address - Phone:812-279-8232
Mailing Address - Fax:812-279-5884
Practice Address - Street 1:2809 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5310
Practice Address - Country:US
Practice Address - Phone:812-279-8232
Practice Address - Fax:812-279-5884
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000848A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000201140OtherBLUE CROSS & BLUE SHEILD