Provider Demographics
NPI:1922155605
Name:SMITH, TINA LYNNE (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 GREENBRIAR CHASE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-3214
Mailing Address - Country:US
Mailing Address - Phone:405-691-6567
Mailing Address - Fax:405-735-8136
Practice Address - Street 1:10705 GREENBRIAR CHASE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-3214
Practice Address - Country:US
Practice Address - Phone:405-691-6567
Practice Address - Fax:405-735-8136
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist