Provider Demographics
NPI:1760700868
Name:SMITH, TAMARA M (MA CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EXECUTIVE BLVD 4TH FL
Mailing Address - Street 2:SPEECH AND LEARN
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-457-9095
Mailing Address - Fax:
Practice Address - Street 1:1 EXECUTIVE BLVD 4TH FL
Practice Address - Street 2:SPEECH AND LEARN
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-457-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist