Provider Demographics
NPI:1457910762
Name:SMITH, GEMMA E (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 W COUNTY ROAD 900 N
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:IN
Mailing Address - Zip Code:47342-9014
Mailing Address - Country:US
Mailing Address - Phone:765-808-5841
Mailing Address - Fax:
Practice Address - Street 1:3621 W COUNTY ROAD 900 N
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:IN
Practice Address - Zip Code:47342-9014
Practice Address - Country:US
Practice Address - Phone:765-808-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007180A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist