Provider Demographics
NPI:1669072252
Name:SMITH, EMIKO J (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMIKO
Middle Name:J
Last Name:SMITH
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 1:3400 W MASSINGALE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1471
Mailing Address - Country:US
Mailing Address - Phone:520-579-5000
Mailing Address - Fax:520-579-5029
Practice Address - Street 1:3400 W MASSINGALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1471
Practice Address - Country:US
Practice Address - Phone:520-579-5000
Practice Address - Fax:520-579-5029
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP12358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP12358OtherARIZOA DEPARTMENT OF HEALTH SERVICES