Provider Demographics
NPI:1487721577
Name:SMITH, DEBRA ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
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 1:9047 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4605
Mailing Address - Country:US
Mailing Address - Phone:865-539-1928
Mailing Address - Fax:865-539-6461
Practice Address - Street 1:9047 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 115
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4605
Practice Address - Country:US
Practice Address - Phone:865-539-1928
Practice Address - Fax:865-539-6461
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000941718AMedicaid