Provider Demographics
NPI:1033608948
Name:SMITH, MARCELLA YUVONNE (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MISS
First Name:MARCELLA
Middle Name:YUVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 AVERILL DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6824
Mailing Address - Country:US
Mailing Address - Phone:757-494-7600
Mailing Address - Fax:
Practice Address - Street 1:2248 AVERILL DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-6824
Practice Address - Country:US
Practice Address - Phone:757-558-8923
Practice Address - Fax:757-558-4486
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2203000241Medicaid