Provider Demographics
NPI:1558146415
Name:SMITH, MAURA MITCHELL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:MITCHELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7720 HIGHWAY 165 STE 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-5348
Mailing Address - Country:US
Mailing Address - Phone:318-936-2004
Mailing Address - Fax:318-965-7434
Practice Address - Street 1:7720 HIGHWAY 165 STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-5348
Practice Address - Country:US
Practice Address - Phone:318-936-2004
Practice Address - Fax:318-965-7434
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA8495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist