Provider Demographics
NPI:1871073494
Name:CITTY, TIFFANY N I (MS-CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:CITTY
Suffix:I
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:N
Other - Last Name:HANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:199 BLOSSOM ST STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4415
Mailing Address - Country:US
Mailing Address - Phone:281-824-1000
Mailing Address - Fax:281-562-7840
Practice Address - Street 1:617 COLE ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4903
Practice Address - Country:US
Practice Address - Phone:281-824-1000
Practice Address - Fax:281-562-7840
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112513OtherTDLR
14174407OtherASHA CCC