Provider Demographics
NPI:1972835569
Name:SMITH, MICHELLE K (SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W DRAKE RD
Mailing Address - Street 2:SUITE 133
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5558
Mailing Address - Country:US
Mailing Address - Phone:970-494-6449
Mailing Address - Fax:970-494-6447
Practice Address - Street 1:802 W DRAKE RD
Practice Address - Street 2:SUITE 133
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5558
Practice Address - Country:US
Practice Address - Phone:970-494-6449
Practice Address - Fax:970-494-6447
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12062984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist