Provider Demographics
NPI:1811423049
Name:SMITH, NOELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
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 1:6050 22ND RD N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3410
Mailing Address - Country:US
Mailing Address - Phone:717-364-6274
Mailing Address - Fax:
Practice Address - Street 1:5695 KING CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5745
Practice Address - Country:US
Practice Address - Phone:540-720-2261
Practice Address - Fax:540-720-5660
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist