Provider Demographics
NPI:1154736411
Name:SMITH, STEPHANIE LEIGH
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WILDWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044
Mailing Address - Country:US
Mailing Address - Phone:412-487-7771
Mailing Address - Fax:415-487-7772
Practice Address - Street 1:3950 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1870
Practice Address - Country:US
Practice Address - Phone:724-519-7722
Practice Address - Fax:724-519-2910
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1718235Z00000X
PA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103049750-0001Medicaid
PA103049750-0002Medicaid