Provider Demographics
NPI:1538117882
Name:SMITH, RANDI MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 RIVER GREEN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0388
Mailing Address - Country:US
Mailing Address - Phone:704-532-7942
Mailing Address - Fax:
Practice Address - Street 1:5007 RIVER GREEN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-0388
Practice Address - Country:US
Practice Address - Phone:704-532-7942
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412071Medicaid
NC138V5OtherBCBS