Provider Demographics
NPI:1205824703
Name:SMITH, STEVEN BRAD (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRAD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AVENIDA LA COSTA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4041
Mailing Address - Country:US
Mailing Address - Phone:505-823-2051
Mailing Address - Fax:
Practice Address - Street 1:9500 MONTOMERY NE
Practice Address - Street 2:SUITE 215
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-247-4224
Practice Address - Fax:505-247-1772
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3541231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71530274Medicaid
NM71530274Medicaid
NM71530274Medicaid