Provider Demographics
NPI:1558082370
Name:NESMITH, SUSIE LEIGH
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:LEIGH
Last Name:NESMITH
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 1:100 W PECAN ST
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-2577
Mailing Address - Country:US
Mailing Address - Phone:903-696-0015
Mailing Address - Fax:
Practice Address - Street 1:701 SUMMIT HILL PKWY
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:TX
Practice Address - Zip Code:75459-2900
Practice Address - Country:US
Practice Address - Phone:903-745-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist