Provider Demographics
NPI:1891510384
Name:SMITH, STEPHANIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03470-4805
Mailing Address - Country:US
Mailing Address - Phone:413-522-0243
Mailing Address - Fax:
Practice Address - Street 1:585 OLD HOMESTEAD HWY
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446-2303
Practice Address - Country:US
Practice Address - Phone:603-352-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist