Healthcare Provider Details

I. General information

NPI: 1538288980
Provider Name (Legal Business Name): MICHELLE ANN SMITH MS CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S CONGRESS AVE
WEST PALM BEACH FL
33409-3823
US

IV. Provider business mailing address

4253 SW MUNCIE ST
PORT ST LUCIE FL
33409-0000
US

V. Phone/Fax

Practice location:
  • Phone: 561-640-0013
  • Fax: 561-471-1966
Mailing address:
  • Phone: 772-871-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA3229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: