Provider Demographics
NPI:1184812240
Name:LEACH, TIFFANY ANN (MS, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANN
Last Name:LEACH
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1689 SECRET SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-5810
Mailing Address - Country:US
Mailing Address - Phone:940-895-3597
Mailing Address - Fax:
Practice Address - Street 1:1689 SECRET SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-5810
Practice Address - Country:US
Practice Address - Phone:940-895-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist