Provider Demographics
NPI:1336703545
Name:HODGES, TIFFANY LEIGH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:HODGES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6066
Mailing Address - Country:US
Mailing Address - Phone:972-898-5443
Mailing Address - Fax:
Practice Address - Street 1:2990 LEGACY DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6066
Practice Address - Country:US
Practice Address - Phone:469-888-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist