Provider Demographics
NPI:1538281548
Name:SMITH, ADRIENNE L (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9043 BUCKHORN LN
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-8273
Mailing Address - Country:US
Mailing Address - Phone:810-231-4175
Mailing Address - Fax:
Practice Address - Street 1:11060 HI TECH DR
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9133
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12010283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist