Provider Demographics
NPI:1649570946
Name:SMITHWICK, SELMA I (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SELMA
Middle Name:I
Last Name:SMITHWICK
Suffix:
Gender:F
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 1:360 MONTE VISTA AVENUE
Mailing Address - Street 2:#304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4582
Mailing Address - Country:US
Mailing Address - Phone:925-497-1989
Mailing Address - Fax:
Practice Address - Street 1:360 MONTE VISTA AVENUE
Practice Address - Street 2:#304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4582
Practice Address - Country:US
Practice Address - Phone:925-497-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist