Provider Demographics
NPI:1699066506
Name:SMITH, EMILY ELAINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MAGNOLIA AVE E
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-2152
Mailing Address - Country:US
Mailing Address - Phone:940-395-6991
Mailing Address - Fax:
Practice Address - Street 1:86 MAGNOLIA AVE E
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-2152
Practice Address - Country:US
Practice Address - Phone:940-395-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist