Provider Demographics
NPI:1659694438
Name:SMOOT, KAREN MARTY (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARTY
Last Name:SMOOT
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:MARTY
Other - Last Name:SMOOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC/SLP
Mailing Address - Street 1:70 S SHERWOOD GLN
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8749
Mailing Address - Country:US
Mailing Address - Phone:719-488-0711
Mailing Address - Fax:
Practice Address - Street 1:70 S SHERWOOD GLN
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8749
Practice Address - Country:US
Practice Address - Phone:719-488-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO076958Medicaid