Provider Demographics
NPI:1326229717
Name:SMITH, INGRID EUPHEMIA (MS,CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:INGRID
Middle Name:EUPHEMIA
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 1:1326 PORTA ROSA LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2368
Mailing Address - Country:US
Mailing Address - Phone:832-519-4741
Mailing Address - Fax:
Practice Address - Street 1:1326 PORTA ROSA LN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2368
Practice Address - Country:US
Practice Address - Phone:832-519-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist