MEDICARE: MS. DEBORAH KAY SMITH MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	16504	TX

General Provider Information

NPI Number	:	1336212984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH KAY SMITH MS, CCC-SLP

Provider Business Mailing Address
First Line	:	707 EULALIA DR
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-1649
Country	:	US
Telephone Number	:	972-563-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 RIDGE RD # A
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75087-4242
Country	:	US
Telephone Number	:	972-722-7016
Fax Number	:	972-722-7076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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