Provider Demographics
NPI:1316430416
Name:SMITH, MARGUERITE REGINA (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:REGINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4668 PEMBROKE BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6423
Mailing Address - Country:US
Mailing Address - Phone:757-648-8562
Mailing Address - Fax:757-648-8564
Practice Address - Street 1:41 OLD OYSTER POINT RD STE E
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7177
Practice Address - Country:US
Practice Address - Phone:757-223-1466
Practice Address - Fax:757-223-1467
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist