Provider Demographics
NPI:1699195594
Name:SMITH, MAGGIE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W OLYMPIC PL APT 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3658
Mailing Address - Country:US
Mailing Address - Phone:425-657-0620
Mailing Address - Fax:
Practice Address - Street 1:1871 NW GILMAN BLVD # 2
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8116
Practice Address - Country:US
Practice Address - Phone:425-657-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist