Provider Demographics
NPI:1013068196
Name:SMITH, DONNA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3256
Mailing Address - Country:US
Mailing Address - Phone:972-841-9367
Mailing Address - Fax:
Practice Address - Street 1:1351 E BARDIN RD STE 160
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-2136
Practice Address - Country:US
Practice Address - Phone:817-795-1291
Practice Address - Fax:866-208-8978
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist