Provider Demographics
NPI:1649585894
Name:DORRIS, TAMMY LEAH (MED CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEAH
Last Name:DORRIS
Suffix:
Gender:F
Credentials:MED CCC/SLP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 CUMBERLAND RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6002
Mailing Address - Country:US
Mailing Address - Phone:270-792-3621
Mailing Address - Fax:270-781-6483
Practice Address - Street 1:525 CUMBERLAND RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6002
Practice Address - Country:US
Practice Address - Phone:270-792-3621
Practice Address - Fax:270-781-6483
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142993235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist