Provider Demographics
NPI:1174070346
Name:KELLY, TIFFANY (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:KELLY
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 1:6809 GALWAY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-3409
Mailing Address - Country:US
Mailing Address - Phone:972-914-9126
Mailing Address - Fax:
Practice Address - Street 1:6809 GALWAY DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-3409
Practice Address - Country:US
Practice Address - Phone:972-914-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2865235Z00000X
CA23846235Z00000X
TX16698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist