Provider Demographics
NPI:1164778577
Name:CHAPMAN, TIFFANY LAKEN (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LAKEN
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BROWNLEE RD
Mailing Address - Street 2:
Mailing Address - City:HINESTON
Mailing Address - State:LA
Mailing Address - Zip Code:71438-9739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 BROWNLEE RD
Practice Address - Street 2:
Practice Address - City:HINESTON
Practice Address - State:LA
Practice Address - Zip Code:71438-9739
Practice Address - Country:US
Practice Address - Phone:318-452-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist