Provider Demographics
NPI:1356733968
Name:POORE, TIFFANY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:POORE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PINE LAKES LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37853-3201
Mailing Address - Country:US
Mailing Address - Phone:865-250-0679
Mailing Address - Fax:
Practice Address - Street 1:421 PINE LAKES LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:TN
Practice Address - Zip Code:37853-3201
Practice Address - Country:US
Practice Address - Phone:865-250-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist