Provider Demographics
NPI:1669192324
Name:SMITH, ISSA ALEXANDRA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ISSA
Middle Name:ALEXANDRA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ADAMS ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1610
Mailing Address - Country:US
Mailing Address - Phone:703-861-3394
Mailing Address - Fax:
Practice Address - Street 1:4200 PARLIAMENT PL STE 550
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1883
Practice Address - Country:US
Practice Address - Phone:240-245-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist