Provider Demographics
NPI:1962845008
Name:SMITH, TENIYA (BS SLP)
Entity Type:Individual
Prefix:
First Name:TENIYA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 W HARWELL RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2790
Mailing Address - Country:US
Mailing Address - Phone:602-237-7129
Mailing Address - Fax:
Practice Address - Street 1:6433 W HARWELL RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2790
Practice Address - Country:US
Practice Address - Phone:602-237-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL52702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant