Provider Demographics
NPI:1225586746
Name:SMITH, CAMILLE (MS)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3557 S HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4008
Mailing Address - Country:US
Mailing Address - Phone:801-916-1873
Mailing Address - Fax:
Practice Address - Street 1:440 D ST STE 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2827
Practice Address - Country:US
Practice Address - Phone:801-408-5456
Practice Address - Fax:801-408-1810
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9876599-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist