Healthcare Provider Details

I. General information

NPI: 1386068880
Provider Name (Legal Business Name): LAURA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 STATE ROUTE 303
RAVENNA OH
44266-9718
US

IV. Provider business mailing address

7320 N PALMYRA RD
CANFIELD OH
44406-9709
US

V. Phone/Fax

Practice location:
  • Phone: 330-235-9441
  • Fax: 330-235-9464
Mailing address:
  • Phone: 330-533-8755
  • Fax: 330-533-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP8867
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: