Provider Demographics
NPI:1336341221
Name:SMITH, AMIE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3938
Mailing Address - Country:US
Mailing Address - Phone:870-926-0792
Mailing Address - Fax:
Practice Address - Street 1:1129 OLIVE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3938
Practice Address - Country:US
Practice Address - Phone:870-926-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist