Provider Demographics
NPI:1558052076
Name:SMITH, LAUREL ELIZABETH (AUD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 BARNHART AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3305
Mailing Address - Country:US
Mailing Address - Phone:330-685-3263
Mailing Address - Fax:
Practice Address - Street 1:9000 N MAIN ST STE 319
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1185
Practice Address - Country:US
Practice Address - Phone:937-832-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02438231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist