Provider Demographics
NPI:1144788993
Name:SMITH, MARC
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 IRVING STREET
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335
Mailing Address - Country:US
Mailing Address - Phone:870-633-1485
Mailing Address - Fax:870-633-1415
Practice Address - Street 1:400 DAWSON RD.
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335
Practice Address - Country:US
Practice Address - Phone:870-633-3248
Practice Address - Fax:870-261-1825
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist