Provider Demographics
NPI:1346801800
Name:SMITH, CHRISTINE ELIZABETH (MS-SLP CCC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS-SLP CCC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:VERMEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4509 CANYON RDG
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3705
Mailing Address - Country:US
Mailing Address - Phone:214-773-5214
Mailing Address - Fax:
Practice Address - Street 1:2170 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1919
Practice Address - Country:US
Practice Address - Phone:254-899-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist