Provider Demographics
NPI:1114163193
Name:SMITH, DANA HOWARD (MS, CCC/SLP)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:HOWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, CCC/SLP
Other - Prefix:MR
Other - First Name:DANA
Other - Middle Name:HOWARD
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:281 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2138
Mailing Address - Country:US
Mailing Address - Phone:508-334-1000
Mailing Address - Fax:508-856-3460
Practice Address - Street 1:281 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2138
Practice Address - Country:US
Practice Address - Phone:508-334-1000
Practice Address - Fax:508-856-3460
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist