Provider Demographics
NPI:1649646043
Name:SMITH, ZACHARY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:SMITH
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 1:4041 RADFORD AVE
Mailing Address - Street 2:#402
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2104
Mailing Address - Country:US
Mailing Address - Phone:602-397-0013
Mailing Address - Fax:
Practice Address - Street 1:4041 RADFORD AVE
Practice Address - Street 2:#402
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2104
Practice Address - Country:US
Practice Address - Phone:602-397-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist