Provider Demographics
NPI:1972968667
Name:IBERG, TIFFANY (BC-HIS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:IBERG
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 1:975 E EDWARDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1823
Mailing Address - Country:US
Mailing Address - Phone:618-259-0700
Mailing Address - Fax:618-259-0761
Practice Address - Street 1:975 E EDWARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1823
Practice Address - Country:US
Practice Address - Phone:618-259-0700
Practice Address - Fax:618-259-0761
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2945237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist