Provider Demographics
NPI:1780989632
Name:SMITH, TASHA RENEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LOUIS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5181
Mailing Address - Country:US
Mailing Address - Phone:423-246-4600
Mailing Address - Fax:423-246-3311
Practice Address - Street 1:301 LOUIS STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-246-4600
Practice Address - Fax:423-246-3311
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist