Provider Demographics
NPI:1609323211
Name:SMITH, DEIRDRE (MS SLP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 WHITEMAN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2720
Mailing Address - Country:US
Mailing Address - Phone:302-547-6055
Mailing Address - Fax:
Practice Address - Street 1:61 CORPORATE CIRCLE
Practice Address - Street 2:EASTER SEALS DE & MD
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720
Practice Address - Country:US
Practice Address - Phone:302-324-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0000502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist