Provider Demographics
NPI:1609305226
Name:FANNIN, TIFFANY (LISW, CDCA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:FANNIN
Suffix:
Gender:F
Credentials:LISW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 TREE BEND CIR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8263
Mailing Address - Country:US
Mailing Address - Phone:614-832-0447
Mailing Address - Fax:
Practice Address - Street 1:6895 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2289
Practice Address - Country:US
Practice Address - Phone:614-845-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical