Provider Demographics
NPI:1831330042
Name:SMITH, BEATRICE RUTH (AUD)
Entity type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:RUTH
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:BEA
Other - Middle Name:R
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:3607 MANOR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-478-2273
Mailing Address - Fax:512-472-0921
Practice Address - Street 1:3607 MANOR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-478-2273
Practice Address - Fax:512-472-0921
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01674231H00000X
TX80711231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80711OtherTEXAS STATE LICENSE