=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205770393
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY GRACE SMITH CF-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2026
-----------------------------------------------------
Last Update Date | 04/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 714 GREEN VALLEY RD
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27408-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-370-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 DEER RUN DR APT 9
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28752-3164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-803-9911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1313412
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------