Provider Demographics
NPI:1073892824
Name:SMITH, ALLISON M (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 GOOCH LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8366
Mailing Address - Country:US
Mailing Address - Phone:318-450-7268
Mailing Address - Fax:
Practice Address - Street 1:327 OLD HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-4000
Practice Address - Country:US
Practice Address - Phone:256-517-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist