Provider Demographics
NPI:1194701508
Name:SMITH, LINAE MARIA (CCC-A)
Entity type:Individual
Prefix:MS
First Name:LINAE
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:MS
Other - First Name:LINAE
Other - Middle Name:M
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CC-A
Mailing Address - Street 1:PO BOX 3178
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3178
Mailing Address - Country:US
Mailing Address - Phone:319-398-1583
Mailing Address - Fax:319-399-2085
Practice Address - Street 1:202 10TH STREET SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2404
Practice Address - Country:US
Practice Address - Phone:319-399-2022
Practice Address - Fax:319-399-2014
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00458231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist