Healthcare Provider Details

I. General information

NPI: 1114694973
Provider Name (Legal Business Name): ROCHELLE J. SMITH SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 W NEW HAVEN AVE STE 105
MELBOURNE FL
32904-3908
US

IV. Provider business mailing address

250 SAGECREST CIR APT 2-201
MELBOURNE FL
32904-8680
US

V. Phone/Fax

Practice location:
  • Phone: 321-768-6119
  • Fax: 321-768-1710
Mailing address:
  • Phone: 713-562-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA18644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: