Provider Demographics
NPI:1699341123
Name:SMITH, MIKAYLA LOREN (CF-SLP)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:LOREN
Last Name:SMITH
Suffix:
Gender:F
Credentials: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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45682-0374
Mailing Address - Country:US
Mailing Address - Phone:740-590-6293
Mailing Address - Fax:
Practice Address - Street 1:1909 LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4431
Practice Address - Country:US
Practice Address - Phone:347-497-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist