=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346487717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACEE WILLIAMS SMITH M.S., SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 01/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2853 HAMMOCK DR
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33566-6753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-707-8044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2853 HAMMOCK DR
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33566-6753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-707-8044
-----------------------------------------------------
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 | SA 3893
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------