Provider Demographics
NPI:1992909360
Name:SMITH, AUDREY WILLIAMS (MS-CCC,SLP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:WILLIAMS
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 1:969 NORWALK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3933
Mailing Address - Country:US
Mailing Address - Phone:615-885-8314
Mailing Address - Fax:
Practice Address - Street 1:300 STONECREST BLVD STE 375
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6825
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist