Provider Demographics
NPI:1518476209
Name:SMITH, EMILY L WALKER
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L WALKER
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 1:397 ENQUIRER CT APT 301
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2298
Mailing Address - Country:US
Mailing Address - Phone:870-370-2612
Mailing Address - Fax:
Practice Address - Street 1:168 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4820
Practice Address - Country:US
Practice Address - Phone:870-367-4333
Practice Address - Fax:870-367-4334
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
AR200351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist