Provider Demographics
NPI:1225824618
Name:THOMPSON, TIFFANY JANIELLE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JANIELLE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 BLUESTONE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2365
Mailing Address - Country:US
Mailing Address - Phone:440-317-4546
Mailing Address - Fax:
Practice Address - Street 1:3010 BLUESTONE LN
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2365
Practice Address - Country:US
Practice Address - Phone:440-317-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator