Provider Demographics
NPI:1346550340
Name:SMITH-POMEROY, MAGGIE JANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:JANE
Last Name:SMITH-POMEROY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11489 LAPP RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8669
Mailing Address - Country:US
Mailing Address - Phone:585-567-8128
Mailing Address - Fax:
Practice Address - Street 1:15 ELM ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1014
Practice Address - Country:US
Practice Address - Phone:585-968-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-09
Last Update Date:2010-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist