Provider Demographics
NPI:1710454038
Name:JOE, TIFFANY (MS, CCC-SLP; IBCLC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:JOE
Suffix:
Gender:F
Credentials:MS, CCC-SLP; IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 LANGE CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2353
Mailing Address - Country:US
Mailing Address - Phone:214-868-0090
Mailing Address - Fax:
Practice Address - Street 1:6329 LANGE CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2353
Practice Address - Country:US
Practice Address - Phone:214-868-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-143923174N00000X
TX103326235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty