Healthcare Provider Details

I. General information

NPI: 1932226859
Provider Name (Legal Business Name): MRS. SHIRLEY HOUSTON SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 N AIRLINE AVE
GRAMERCY LA
70052-3634
US

IV. Provider business mailing address

856 N AIRLINE AVE
GRAMERCY LA
70052-3634
US

V. Phone/Fax

Practice location:
  • Phone: 225-869-9767
  • Fax: 225-869-8185
Mailing address:
  • Phone: 225-869-9767
  • Fax: 225-869-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1871
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: