Provider Demographics
NPI:1043927007
Name:SMITH, ERIN EILEEN (MA-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:EILEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:EILEEN
Other - Last Name:CULLEN,
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC-SLP
Mailing Address - Street 1:1389 TORGERSON RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-8450
Mailing Address - Country:US
Mailing Address - Phone:407-637-9633
Mailing Address - Fax:
Practice Address - Street 1:1389 TORGERSON RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-8450
Practice Address - Country:US
Practice Address - Phone:407-637-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist