Provider Demographics
NPI:1942407911
Name:SMITH, DENISE RAE (MA)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-7575
Mailing Address - Country:US
Mailing Address - Phone:575-649-0185
Mailing Address - Fax:
Practice Address - Street 1:3028 CAMINO REAL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-7575
Practice Address - Country:US
Practice Address - Phone:575-649-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC4135235Z00000X
NMSLP4313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist