Provider Demographics
NPI:1003952987
Name:SMITH, ANN RITA (MS CCCSLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:RITA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8201
Mailing Address - Country:US
Mailing Address - Phone:207-939-6514
Mailing Address - Fax:
Practice Address - Street 1:12 OVERLOOK DRIVE
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8201
Practice Address - Country:US
Practice Address - Phone:207-939-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME037622OtherANTHEM BCBS
ME247870099Medicaid