Provider Demographics
NPI:1558931543
Name:SMITH, MARIAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
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 1:1117 S 9TH ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:PORT ARANSAS
Mailing Address - State:TX
Mailing Address - Zip Code:78373-5524
Mailing Address - Country:US
Mailing Address - Phone:361-290-1315
Mailing Address - Fax:
Practice Address - Street 1:320 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9348
Practice Address - Country:US
Practice Address - Phone:361-290-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81381231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty