Provider Demographics
NPI:1730574195
Name:GLADNEY, TIFFANIE J (MCD CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANIE
Middle Name:J
Last Name:GLADNEY
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-2201
Mailing Address - Country:US
Mailing Address - Phone:318-603-6300
Mailing Address - Fax:
Practice Address - Street 1:1961 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-2200
Practice Address - Country:US
Practice Address - Phone:318-603-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist