Provider Demographics
NPI:1114103967
Name:SMITH, NATALIE W (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 LAKESHORE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6762
Mailing Address - Country:US
Mailing Address - Phone:205-868-0147
Mailing Address - Fax:
Practice Address - Street 1:2204 LAKESHORE DR STE 160
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-6762
Practice Address - Country:US
Practice Address - Phone:205-868-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist