Provider Demographics
NPI:1790093920
Name:SMITH, GLADYS (GLADYS SMITH)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:GLADYS SMITH
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:SMITH-KONYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSCCC/SLP
Mailing Address - Street 1:580 CLIFTON PARK CTR RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4837
Mailing Address - Country:US
Mailing Address - Phone:646-456-6841
Mailing Address - Fax:646-792-3260
Practice Address - Street 1:580 CLIFTON PARK CTR RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4837
Practice Address - Country:US
Practice Address - Phone:646-456-6841
Practice Address - Fax:646-792-3260
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012904-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist