Provider Demographics
NPI:1447614185
Name:NESMITH, TAWNY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAWNY
Middle Name:
Last Name:NESMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12741 TANADA LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3825
Mailing Address - Country:US
Mailing Address - Phone:913-309-7973
Mailing Address - Fax:
Practice Address - Street 1:12741 TANADA LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3825
Practice Address - Country:US
Practice Address - Phone:913-309-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK135737235Z00000X
101Y00000X
MO2017029118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor