Provider Demographics
NPI:1477974848
Name:SMITH, CAREY E (MS-CCC SLP)
Entity Type:Individual
Prefix:MISS
First Name:CAREY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS-CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 THE PROMENADE N
Mailing Address - Street 2:#331
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 E BROADWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3162
Practice Address - Country:US
Practice Address - Phone:562-367-4982
Practice Address - Fax:562-684-4268
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist