Provider Demographics
NPI:1659611721
Name:TUNCLE-COCKERHAM, TIFFANY MONIQUE (SLP,CCC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MONIQUE
Last Name:TUNCLE-COCKERHAM
Suffix:
Gender:F
Credentials:SLP,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 MAGNOLIA BEND DR.
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-6089
Mailing Address - Country:US
Mailing Address - Phone:281-773-6616
Mailing Address - Fax:
Practice Address - Street 1:4719 MAGNOLIA BEND DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-6089
Practice Address - Country:US
Practice Address - Phone:281-773-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105646OtherSTATE LICENSE