Provider Demographics
NPI:1699954727
Name:WOHLFORD, TIFFANY LEA (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEA
Last Name:WOHLFORD
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-8996
Mailing Address - Country:US
Mailing Address - Phone:304-431-3344
Mailing Address - Fax:
Practice Address - Street 1:763 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-8996
Practice Address - Country:US
Practice Address - Phone:304-431-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist