Provider Demographics
NPI:1043036940
Name:MAI, TIFFANY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 BROOKHOLLOW DR STE A-100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5426
Mailing Address - Country:US
Mailing Address - Phone:949-771-5881
Mailing Address - Fax:
Practice Address - Street 1:1524 BROOKHOLLOW DR STE A-100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5426
Practice Address - Country:US
Practice Address - Phone:949-771-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP37908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist