Provider Demographics
NPI:1891532883
Name:SMITH, SAMUEL GLENN (AUD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GLENN
Last Name:SMITH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8258
Mailing Address - Country:US
Mailing Address - Phone:575-521-9795
Mailing Address - Fax:
Practice Address - Street 1:4351 E LOHMAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8258
Practice Address - Country:US
Practice Address - Phone:575-521-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist