Provider Demographics
NPI:1760523898
Name:SMART, ORLANDO DARNELL (SLP)
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:DARNELL
Last Name:SMART
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9355
Mailing Address - Country:US
Mailing Address - Phone:608-438-4393
Mailing Address - Fax:608-884-4393
Practice Address - Street 1:1077 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-9355
Practice Address - Country:US
Practice Address - Phone:608-438-4393
Practice Address - Fax:608-884-6953
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist