Healthcare Provider Details

I. General information

NPI: 1245782077
Provider Name (Legal Business Name): MICHELLE SMILEY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5403
US

IV. Provider business mailing address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5403
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-3000
  • Fax:
Mailing address:
  • Phone: 916-423-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14113418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: