Provider Demographics
NPI:1538406160
Name:HODGE, TIFFANY ANN (MS, CFY - SLP)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANN
Last Name:HODGE
Suffix:
Gender:F
Credentials:MS, CFY - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 I 55 N
Mailing Address - Street 2:SUITE 291, HIGHLAND VILLAGE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5930
Mailing Address - Country:US
Mailing Address - Phone:601-362-0859
Mailing Address - Fax:601-362-0870
Practice Address - Street 1:4500 I 55 N
Practice Address - Street 2:SUITE 291, HIGHLAND VILLAGE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5930
Practice Address - Country:US
Practice Address - Phone:601-362-0859
Practice Address - Fax:601-362-0870
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist