Provider Demographics
NPI:1962740795
Name:SMITH, NORMA CASTANEDA (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:CASTANEDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 SKYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5209
Mailing Address - Country:US
Mailing Address - Phone:847-682-5909
Mailing Address - Fax:
Practice Address - Street 1:10721 SKYHAWK DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5209
Practice Address - Country:US
Practice Address - Phone:847-682-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA10206OtherFLORIDA STATE SLP LICENSE