Provider Demographics
NPI:1871849893
Name:SMITH, ALLY W (SLP)
Entity Type:Individual
Prefix:
First Name:ALLY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 S CREST RD
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-1508
Mailing Address - Country:US
Mailing Address - Phone:423-580-3219
Mailing Address - Fax:
Practice Address - Street 1:604 BLACK ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3300
Practice Address - Country:US
Practice Address - Phone:423-708-2014
Practice Address - Fax:833-377-0537
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist