Healthcare Provider Details

I. General information

NPI: 1821219601
Provider Name (Legal Business Name): COURTNEY MARIE SMITH M.S., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 ROLLING OAK BLVD
LOUISVILLE KS
40214
US

IV. Provider business mailing address

9212 WOODDALE DRIVE
LOUISVILLE KY
40272
US

V. Phone/Fax

Practice location:
  • Phone: 502-386-8509
  • Fax:
Mailing address:
  • Phone: 502-935-3794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number07-020
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: