Provider Demographics
NPI:1821481177
Name:SMITH, ANGELIA (MED,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WALKER FARM RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-3510
Mailing Address - Country:US
Mailing Address - Phone:850-380-6399
Mailing Address - Fax:
Practice Address - Street 1:109 WALKER FARM RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-3510
Practice Address - Country:US
Practice Address - Phone:850-380-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist