Provider Demographics
NPI:1760091144
Name:SMITH, IRMA ESTELA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:ESTELA
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 1:1315 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2953
Mailing Address - Country:US
Mailing Address - Phone:214-923-1363
Mailing Address - Fax:
Practice Address - Street 1:17430 CAMPBELL RD STE 112
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5297
Practice Address - Country:US
Practice Address - Phone:214-628-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist