Provider Demographics
NPI:1770070062
Name:SMITH, MARCIA LYNNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNNE
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 1:10155 TENNYSON DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3647
Mailing Address - Country:US
Mailing Address - Phone:248-252-6064
Mailing Address - Fax:866-718-3006
Practice Address - Street 1:10155 TENNYSON DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3647
Practice Address - Country:US
Practice Address - Phone:248-252-6064
Practice Address - Fax:866-718-3006
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist