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General NPI Number Information
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NPI Number | 1104087642
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Entity Type | Individual
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Provider Name | TRACY F SMITH MS CCCSLP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 600 SCHOOLHOUSE RD
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City | DANVILLE
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State | PA
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Zip | 17821
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Country | US
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Telephone | 570-275-6100
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Fax | 570-275-7267
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Provider Business Mailing Address
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Address Line | 1386 OLD FREEPORT ROAD SUITE 3B
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City | PITTSBURG
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State | PA
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Zip | 15238
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Country | US
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Telephone | 888-734-2202
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Fax | 888-293-6854
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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 | SL007112
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License Number State | PA
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