Provider Demographics
NPI:1003427394
Name:SMITH, EMILY MARICE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARICE
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 1:7212 NW EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5309
Mailing Address - Country:US
Mailing Address - Phone:580-695-2088
Mailing Address - Fax:
Practice Address - Street 1:2000 S COLORADO BLVD # T1-7300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7900
Practice Address - Country:US
Practice Address - Phone:786-574-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0367231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist