1770881336 NPI number — MRS. MELANIE SMITH M.S., CCC-SLP

Table of content: MRS. MELANIE SMITH M.S., CCC-SLP (NPI 1770881336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770881336 NPI number — MRS. MELANIE SMITH M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MELANIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770881336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 W HORIZON RIDGE PKWY
Provider Second Line Business Mailing Address:
SUITE #160
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89012-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-566-8255
Provider Business Mailing Address Fax Number:
702-297-6830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 W HORIZON RIDGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89012-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-566-8255
Provider Business Practice Location Address Fax Number:
702-297-6830
Provider Enumeration Date:
03/07/2011

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: 235Z00000X , with the licence number:  SP-1342 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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