Provider Demographics
NPI:1518928332
Name:SMITH, SHARON KAY
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAY
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 1:834 W 4TH ST
Mailing Address - Street 2:BLACK HAWK HEARING AID CENTER
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702
Mailing Address - Country:US
Mailing Address - Phone:319-234-4360
Mailing Address - Fax:319-235-5360
Practice Address - Street 1:834 W 4TH ST
Practice Address - Street 2:BLACK HAWK HEARING AID CENTER
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:319-234-4360
Practice Address - Fax:319-235-5360
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00889237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist