Provider Demographics
NPI:1326447699
Name:SMITH, MAGGIE WALSTON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:WALSTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:N
Other - Last Name:WALSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-2417
Mailing Address - Country:US
Mailing Address - Phone:252-916-1029
Mailing Address - Fax:252-355-9812
Practice Address - Street 1:300 E ARLINGTON BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5037
Practice Address - Country:US
Practice Address - Phone:252-916-1029
Practice Address - Fax:252-355-9812
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist