Healthcare Provider Details

I. General information

NPI: 1376891663
Provider Name (Legal Business Name): TIFFANY TAYLOR SMITH M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY DEAN TAYLOR M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 HIGHWAY 511
CORBIN KY
40701-8487
US

IV. Provider business mailing address

1277 HIGHWAY 511
CORBIN KY
40701-8487
US

V. Phone/Fax

Practice location:
  • Phone: 606-524-0734
  • Fax:
Mailing address:
  • Phone: 606-524-0734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number141150
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: