Provider Demographics
NPI:1114271608
Name:SMOTHERS, MONICA KAYE ORTLIEB (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:KAYE ORTLIEB
Last Name:SMOTHERS
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 1:101 WATERMERE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8116
Mailing Address - Country:US
Mailing Address - Phone:817-431-8668
Mailing Address - Fax:817-337-7622
Practice Address - Street 1:101 WATERMERE DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8116
Practice Address - Country:US
Practice Address - Phone:817-431-8668
Practice Address - Fax:817-337-7622
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist