Provider Demographics
NPI:1427275106
Name:LEECH, TIFFANY BOONE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:BOONE
Last Name:LEECH
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 1:210 OLD WHARF LN
Mailing Address - Street 2:
Mailing Address - City:QUEENSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21658-1250
Mailing Address - Country:US
Mailing Address - Phone:410-353-8315
Mailing Address - Fax:
Practice Address - Street 1:9325 CREEK LN
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620
Practice Address - Country:US
Practice Address - Phone:410-778-6565
Practice Address - Fax:410-778-1448
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist