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General NPI Number Information
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NPI Number | 1215470687
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Entity Type | Individual
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Provider Name | STEPHANIE AUTUMN SMITH M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 2232 N CLYBOURN AVE # 3
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City | CHICAGO
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State | IL
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Zip | 60614-3193
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Country | US
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Telephone | 773-377-5492
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Fax |
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Provider Business Mailing Address
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Address Line | 1560 MAYFLOWER AVE
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City | BRONX
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State | NY
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Zip | 10461-5400
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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 | 027403-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8790
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.018334
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License Number State | IL
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