Provider Demographics
NPI:1093881617
Name:SMITH, BRANDON P (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
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 1:215 MELBA JONES RD
Mailing Address - Street 2:
Mailing Address - City:GREENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-7429
Mailing Address - Country:US
Mailing Address - Phone:270-932-4899
Mailing Address - Fax:
Practice Address - Street 1:215 MELBA JONES RD
Practice Address - Street 2:
Practice Address - City:GREENBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-7429
Practice Address - Country:US
Practice Address - Phone:270-932-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY2454235Z00000X
12047999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist