Provider Demographics
NPI:1861687725
Name:SMITH, NANCY KATHLEEN (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KATHLEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:KATHLEEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:500 S INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5632
Mailing Address - Country:US
Mailing Address - Phone:580-366-7110
Mailing Address - Fax:
Practice Address - Street 1:500 S INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5632
Practice Address - Country:US
Practice Address - Phone:580-366-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist