Provider Demographics
NPI:1215361498
Name:SMYTH, NATASHA ANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:NATASHA
Middle Name:ANNE
Last Name:SMYTH
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 1:301 WASHINGTON ST
Mailing Address - Street 2:APARTMENT 3111
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1944
Mailing Address - Country:US
Mailing Address - Phone:215-527-5921
Mailing Address - Fax:
Practice Address - Street 1:301 WASHINGTON ST
Practice Address - Street 2:APARTMENT 3111
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1944
Practice Address - Country:US
Practice Address - Phone:215-527-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist