Provider Demographics
NPI:1467451773
Name:SMITH, SHAYLA DC (AUD)
Entity type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:DC
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 WILLOWBROOK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6925
Mailing Address - Country:US
Mailing Address - Phone:608-364-4400
Mailing Address - Fax:608-364-4400
Practice Address - Street 1:1406 WILLOWBROOK RD STE 106
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6925
Practice Address - Country:US
Practice Address - Phone:608-364-4400
Practice Address - Fax:608-312-2477
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000997231H00000X
WI467-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41150300Medicaid
WI41150300Medicaid