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General NPI Number Information
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NPI Number | 1982118733
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Entity Type | Individual
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Provider Name | SHANNON C SMITH M.S, SLP/CF
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Gender | Female
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 625 PINEY FOREST RD STE 407
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City | DANVILLE
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State | VA
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Zip | 24540-2870
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Country | US
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Telephone | 434-799-7732
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10566
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City | DANVILLE
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State | VA
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Zip | 24543-5010
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Country | US
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Telephone | 434-799-7732
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Fax | 434-799-7733
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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 | 2202008668
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License Number State | VA
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