Provider Demographics
NPI:1487192787
Name:SMITH, BETTY ANN
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 SLABTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3309
Mailing Address - Country:US
Mailing Address - Phone:419-222-1836
Mailing Address - Fax:419-224-1010
Practice Address - Street 1:1920 SLABTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3309
Practice Address - Country:US
Practice Address - Phone:419-222-1836
Practice Address - Fax:419-224-1010
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist