Provider Demographics
NPI:1407964760
Name:SMITH, BETH ADELLE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ADELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GLANCY ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072
Mailing Address - Country:US
Mailing Address - Phone:615-868-1904
Mailing Address - Fax:615-868-0336
Practice Address - Street 1:110 GLANCY ST
Practice Address - Street 2:SUITE 214
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2326
Practice Address - Country:US
Practice Address - Phone:615-868-1904
Practice Address - Fax:615-868-0336
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001365237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4078916Medicaid
TN3198224Medicare ID - Type Unspecified