Provider Demographics
NPI:1578147740
Name:SMITH, RENATE ELIZABETH (CF-SLP)
Entity Type:Individual
Prefix:
First Name:RENATE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 UPPER STONE AVE APT G
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-9606
Mailing Address - Country:US
Mailing Address - Phone:270-566-1605
Mailing Address - Fax:
Practice Address - Street 1:1313 SAINT ANTHONY PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1765
Practice Address - Country:US
Practice Address - Phone:502-587-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist