Healthcare Provider Details

I. General information

NPI: 1205824703
Provider Name (Legal Business Name): STEVEN BRAD SMITH M.A., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MONTOMERY NE SUITE 215
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

6701 AVENIDA LA COSTA NE
ALBUQUERQUE NM
87109-4041
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4224
  • Fax: 505-247-1772
Mailing address:
  • Phone: 505-823-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: