Provider Demographics
NPI:1255050928
Name:SMOTHERS, NOAH THOMAS (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:THOMAS
Last Name:SMOTHERS
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N STAR AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9333
Mailing Address - Country:US
Mailing Address - Phone:850-329-0796
Mailing Address - Fax:
Practice Address - Street 1:4800 N STAR AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404
Practice Address - Country:US
Practice Address - Phone:850-329-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-10-31
Deactivation Date:2024-01-22
Deactivation Code:
Reactivation Date:2024-10-31
Provider Licenses
StateLicense IDTaxonomies
AL5365235Z00000X
AL235Z00000X
FLSA21346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist