Provider Demographics
NPI:1720625726
Name:SMITH, GENNA NACHE
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:NACHE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 W LINNE RD STE J-9
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8024
Mailing Address - Country:US
Mailing Address - Phone:209-340-9374
Mailing Address - Fax:
Practice Address - Street 1:1660 W LINNE RD STE J-9
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8024
Practice Address - Country:US
Practice Address - Phone:209-340-9374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88502355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant