Provider Demographics
NPI:1639371685
Name:SMITH, ELLIE C (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:C
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1997 S MAIN ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6635
Mailing Address - Country:US
Mailing Address - Phone:540-961-1230
Mailing Address - Fax:540-951-0613
Practice Address - Street 1:1997 S MAIN ST
Practice Address - Street 2:SUITE 601
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6635
Practice Address - Country:US
Practice Address - Phone:540-961-1230
Practice Address - Fax:540-951-0613
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist