Provider Demographics
NPI:1922030691
Name:SMITH, ELIZABETH I (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:I
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6672 GUNPARK DR
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3387
Mailing Address - Country:US
Mailing Address - Phone:303-530-9191
Mailing Address - Fax:303-530-1835
Practice Address - Street 1:6672 GUNPARK DR
Practice Address - Street 2:SUITE 101A
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3387
Practice Address - Country:US
Practice Address - Phone:303-530-9191
Practice Address - Fax:303-530-1835
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07000995Medicaid