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General NPI Number Information
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NPI Number | 1922069566
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Entity Type | Individual
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Provider Name | WALANDA WALKER SMITH PHD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 18789 N REEMS RD STE. 260
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City | SURPRISE
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State | AZ
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Zip | 85374-8648
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Country | US
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Telephone | 623-544-3223
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Fax | 623-544-3694
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Provider Business Mailing Address
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Address Line | 18789 N REEMS RD STE. 260
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City | SURPRISE
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State | AZ
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Zip | 85374-8648
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Country | US
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Telephone | 623-544-3223
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Fax | 623-544-3694
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3289
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3289
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License Number State | AZ
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