Healthcare Provider Details

I. General information

NPI: 1801454624
Provider Name (Legal Business Name): AMANDA HOLLAND SMITH MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S LINWOOD AVE
BALTIMORE MD
21224-3856
US

IV. Provider business mailing address

833 S BOULDIN ST
BALTIMORE MD
21224-4024
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-9146
  • Fax:
Mailing address:
  • Phone: 410-908-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number05144
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: