Provider Demographics
NPI:1487398509
Name:CORLEY, TIFFANY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 GREENBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7919
Mailing Address - Country:US
Mailing Address - Phone:214-842-0063
Mailing Address - Fax:
Practice Address - Street 1:1401 GREENBRIAR LANE
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7919
Practice Address - Country:US
Practice Address - Phone:214-842-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14045455OtherASHA