Provider Demographics
NPI:1376891663
Name:SMITH, TIFFANY TAYLOR (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DEAN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1277 HIGHWAY 511
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8487
Mailing Address - Country:US
Mailing Address - Phone:606-524-0734
Mailing Address - Fax:
Practice Address - Street 1:1277 HIGHWAY 511
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8487
Practice Address - Country:US
Practice Address - Phone:606-524-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist