Provider Demographics
NPI:1710025986
Name:SMITH, BETTE ANN (SLP)
Entity Type:Individual
Prefix:MS
First Name:BETTE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BETTE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:3728 S HWY 287
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-8960
Mailing Address - Country:US
Mailing Address - Phone:417-214-4713
Mailing Address - Fax:
Practice Address - Street 1:3728 S HWY 287
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-8960
Practice Address - Country:US
Practice Address - Phone:903-874-6315
Practice Address - Fax:903-874-6387
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004002164235Z00000X
FLSA 10388235Z00000X
TX108129235Z00000X
NY018139-1235Z00000X
PASL009240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist