Doctor Name: | MRS. NICOLE MARIE SMITH |
NPI Number: | 1548617947 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | 7101004110 |
Business Practice Address: | 2251 E Paris Ave Se Grand Rapids, MI - 495462431 |
Business Phone Number: | 6164477799 |
Business Fax Number: | |
Mailing Address: | 2061 Ontario Ave Ne, GRAND RAPIDS |
State: | MI |
Postal Code: | 495054470 |
Phone Number: | 6165815379 |
Fax Number: | |
NPI Enumeration Date: | 05/16/2016 |
NPI Last Update Date: | 05/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7101004110 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |