Provider Demographics
NPI:1407106198
Name:SMITH, ALISON LOUISE (MA)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 17TH ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3500
Mailing Address - Country:US
Mailing Address - Phone:706-321-0930
Mailing Address - Fax:
Practice Address - Street 1:6298 VETERANS PKWY
Practice Address - Street 2:SUITE 5A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6258
Practice Address - Country:US
Practice Address - Phone:706-322-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8394509-4104235Z00000X
GASLP008463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist