Provider Demographics
NPI:1265821573
Name:SMITH, DEANNA
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4658
Mailing Address - Country:US
Mailing Address - Phone:985-851-4018
Mailing Address - Fax:985-223-0055
Practice Address - Street 1:56369 CURRIER LN
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-2749
Practice Address - Country:US
Practice Address - Phone:985-606-0341
Practice Address - Fax:985-878-9781
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist