Provider Demographics
NPI:1710167010
Name:SMUTKO, NAN COLLEEN (MA)
Entity Type:Individual
Prefix:MRS
First Name:NAN
Middle Name:COLLEEN
Last Name:SMUTKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1879
Mailing Address - Country:US
Mailing Address - Phone:402-426-3056
Mailing Address - Fax:402-426-3052
Practice Address - Street 1:652 S 23RD ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1879
Practice Address - Country:US
Practice Address - Phone:402-426-3056
Practice Address - Fax:402-426-3052
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3235Z00000X
IA01536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist