Provider Demographics
NPI:1578681201
Name:BURICH, TIFFANY LYNNE (MS CCC SLP)
Entity type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:LYNNE
Last Name:BURICH
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 1:3282 HANN HILL RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5967
Mailing Address - Country:US
Mailing Address - Phone:724-977-0779
Mailing Address - Fax:
Practice Address - Street 1:975 EDGEHILL DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4457
Practice Address - Country:US
Practice Address - Phone:724-977-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008515235Z00000X
FLSA 8607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist