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General NPI Number Information
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NPI Number | 1003142175
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Entity Type | Individual
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Provider Name | MEGAN SMITH SLP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 3457 S GREENSBURG RD
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City | LIBERTY
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State | MS
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Zip | 39645-9580
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Country | US
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Telephone | 601-657-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 7173A MOAK RD
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City | SUMMIT
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State | MS
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Zip | 39666-7505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12133854
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License Number State | MS
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