Provider Demographics
NPI:1700591518
Name:SMITH, DENISE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
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 1:25219 CORTE SOMBRERO
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5229
Mailing Address - Country:US
Mailing Address - Phone:951-691-3594
Mailing Address - Fax:
Practice Address - Street 1:25219 CORTE SOMBRERO
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5229
Practice Address - Country:US
Practice Address - Phone:951-691-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP14563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist