Provider Demographics
NPI:1154501377
Name:PIERCE, TISHA GAY (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TISHA
Middle Name:GAY
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 POWERS BLVD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1018
Mailing Address - Country:US
Mailing Address - Phone:870-219-2209
Mailing Address - Fax:
Practice Address - Street 1:217 E CHERRY AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3372
Practice Address - Country:US
Practice Address - Phone:870-932-5551
Practice Address - Fax:870-932-5552
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP 1636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W133OtherAR BLUE CROSS