Provider Demographics
NPI:1134990344
Name:COLON RODRIGUEZ, TIFFANY JAILENE (MS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JAILENE
Last Name:COLON RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 SHIN OAK DR APT 8200
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2482
Mailing Address - Country:US
Mailing Address - Phone:787-469-0542
Mailing Address - Fax:
Practice Address - Street 1:8012 SHIN OAK DR
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2413
Practice Address - Country:US
Practice Address - Phone:210-945-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist