1508065491 NPI number — VICKI BERNARD SMITH M.S., CCC/A

Table of content: VICKI BERNARD SMITH M.S., CCC/A (NPI 1508065491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508065491 NPI number — VICKI BERNARD SMITH M.S., CCC/A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
VICKI
Provider Middle Name:
BERNARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC/A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNARD
Provider Other First Name:
VICKI
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC/A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508065491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14140 SOUTHWEST FWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-3842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-649-7000
Provider Business Mailing Address Fax Number:
281-240-0030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11914 ASTORIA BLVD STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77089-6076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-484-3981
Provider Business Practice Location Address Fax Number:
281-481-0182
Provider Enumeration Date:
07/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  51282 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 51282 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)