Provider Demographics
NPI:1689706277
Name:SMITH, FELECIA (MED,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FELECIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED,CCC-SLP
Mailing Address - Street 1:123 SLATE LN
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8337
Mailing Address - Country:US
Mailing Address - Phone:985-580-1419
Mailing Address - Fax:
Practice Address - Street 1:123 SLATE LN
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-8337
Practice Address - Country:US
Practice Address - Phone:985-580-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3787235Z00000X
LA09125930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1307572Medicaid