Provider Demographics
NPI:1427407675
Name:GALLEGOS, TIYA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIYA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7842 ZUNI ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-4252
Mailing Address - Country:US
Mailing Address - Phone:714-294-8156
Mailing Address - Fax:
Practice Address - Street 1:9100 E FLORIDA AVE APT 6308
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2854
Practice Address - Country:US
Practice Address - Phone:714-294-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002130235Z00000X, 235Z00000X
CA22203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist