Provider Demographics
NPI:1891976163
Name:SMITH, CARRIE ELIZABETH (MA CCC-SLP CERT AVT)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCC-SLP CERT AVT
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1888 CLAYTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6393
Mailing Address - Country:US
Mailing Address - Phone:501-707-5873
Mailing Address - Fax:540-301-3618
Practice Address - Street 1:1330 AMHERST ST
Practice Address - Street 2:SUITE D
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3000
Practice Address - Country:US
Practice Address - Phone:540-514-8486
Practice Address - Fax:540-301-3618
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1660235Z00000X
VA2202008058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist