Provider Demographics
NPI:1033414792
Name:SMITH, ROMAYNE ALISSA (M A, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROMAYNE
Middle Name:ALISSA
Last Name:SMITH
Suffix:
Gender:F
Credentials:M A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 SHARP RD
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-9525
Mailing Address - Country:US
Mailing Address - Phone:301-854-6507
Mailing Address - Fax:301-854-6507
Practice Address - Street 1:4132 SHARP RD
Practice Address - Street 2:
Practice Address - City:GLENELG
Practice Address - State:MD
Practice Address - Zip Code:21737-9525
Practice Address - Country:US
Practice Address - Phone:301-854-6507
Practice Address - Fax:301-854-6507
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist