Provider Demographics
NPI:1154503704
Name:SMITH, CAROLINE C (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0482
Mailing Address - Country:US
Mailing Address - Phone:270-885-7023
Mailing Address - Fax:270-881-3983
Practice Address - Street 1:1717 HIGH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6300
Practice Address - Country:US
Practice Address - Phone:270-885-7023
Practice Address - Fax:270-881-3983
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048406OtherBC/BS
KY27739OtherBLUEGRASS
KY000000048406OtherBC/BS