Provider Demographics
NPI:1447689336
Name:CULLIGAN, TIFFANEY (M A CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANEY
Middle Name:
Last Name:CULLIGAN
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3315
Mailing Address - Country:US
Mailing Address - Phone:503-352-0240
Mailing Address - Fax:
Practice Address - Street 1:9400 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3315
Practice Address - Country:US
Practice Address - Phone:503-352-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist