Provider Demographics
NPI:1699332437
Name:STEPHENSON, TIFFANY (PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:VANSTEENWYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:
Practice Address - Street 1:2205 N IRONWOOD PL STE 100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2487
Practice Address - Country:US
Practice Address - Phone:208-415-0299
Practice Address - Fax:804-807-3799
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
ID175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist