Provider Demographics
NPI:1932226859
Name:SMITH, SHIRLEY HOUSTON
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:HOUSTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 N AIRLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3634
Mailing Address - Country:US
Mailing Address - Phone:225-869-9767
Mailing Address - Fax:225-869-8185
Practice Address - Street 1:856 N AIRLINE AVE
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3634
Practice Address - Country:US
Practice Address - Phone:225-869-9767
Practice Address - Fax:225-869-8185
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306029Medicaid