Provider Demographics
NPI:1528424694
Name:TUCKER, TIFFANY DENISE (SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DENISE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DENISE
Other - Last Name:MATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:10130 GRANT RD
Mailing Address - Street 2:#218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4531
Mailing Address - Country:US
Mailing Address - Phone:281-807-6325
Mailing Address - Fax:
Practice Address - Street 1:10130 GRANT RD
Practice Address - Street 2:#218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4531
Practice Address - Country:US
Practice Address - Phone:281-807-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist