Provider Demographics
NPI:1902186646
Name:SMITH-DARNER, REBECCA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MARIE
Last Name:SMITH-DARNER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2221 LIVERNOIS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1603
Mailing Address - Country:US
Mailing Address - Phone:248-544-0360
Mailing Address - Fax:248-544-0388
Practice Address - Street 1:2221 LIVERNOIS RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1603
Practice Address - Country:US
Practice Address - Phone:248-544-0360
Practice Address - Fax:248-544-0388
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12078225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist