Provider Demographics
NPI:1982381620
Name:VERHOEVEN, TIFFANY LU
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LU
Last Name:VERHOEVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:IL
Mailing Address - Zip Code:61833-7416
Mailing Address - Country:US
Mailing Address - Phone:217-304-2961
Mailing Address - Fax:
Practice Address - Street 1:213 E 4TH ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:IL
Practice Address - Zip Code:61833-7416
Practice Address - Country:US
Practice Address - Phone:217-304-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician