Provider Demographics
NPI:1376568477
Name:SMITH, MARK (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E SPRUCE AVE # 130
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3373
Mailing Address - Country:US
Mailing Address - Phone:559-432-5973
Mailing Address - Fax:
Practice Address - Street 1:1351 E SPRUCE AVE # 130
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3342
Practice Address - Country:US
Practice Address - Phone:559-432-5973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2487231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist