=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346814498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B SMITH SPEECH LANGUAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2021
-----------------------------------------------------
Last Update Date | 05/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 DEHAVEN DR APT 2D
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10703-1264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-222-1437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 DEHAVEN DR APT 2D
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10703-1264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-222-1437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. BRITTNEY M SMITH
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 914-222-1437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------