Provider Demographics
NPI:1740397314
Name:DODSON SMITH, STEPHAINE (ST)
Entity Type:Individual
Prefix:
First Name:STEPHAINE
Middle Name:
Last Name:DODSON SMITH
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 STATE ROAD 580
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3352
Mailing Address - Country:US
Mailing Address - Phone:727-724-5437
Mailing Address - Fax:
Practice Address - Street 1:2759 STATE ROAD 580
Practice Address - Street 2:SUITE 112
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3352
Practice Address - Country:US
Practice Address - Phone:727-724-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist