Provider Demographics
NPI:1225803497
Name:SMITH, AMY C (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 MARTIN L KING ST S
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5443
Mailing Address - Country:US
Mailing Address - Phone:318-669-4182
Mailing Address - Fax:
Practice Address - Street 1:1607 MARTIN L KING ST S
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5443
Practice Address - Country:US
Practice Address - Phone:318-669-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist