Provider Demographics
NPI:1225342850
Name:GRANT, TIFFANY B (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:B
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MONTROSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6906
Mailing Address - Country:US
Mailing Address - Phone:803-767-3712
Mailing Address - Fax:803-957-7898
Practice Address - Street 1:160 MONTROSE DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6906
Practice Address - Country:US
Practice Address - Phone:803-767-3712
Practice Address - Fax:803-957-7898
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist