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NPI Code Detail

MEDICARE: ANGIE SMITH PRUETT MS CCC-SLP

MEDICARE: ANGIE SMITH PRUETT MS CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2190AL

General Provider Information

NPI Number : 1013071208
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGIE SMITH PRUETT MS CCC-SLP
Provider Business Mailing Address
First Line : 2620 RIVER HAVEN LN
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35244-1273
Country : US
Telephone Number : 205-419-0737
Fax Number :
Provider Business Practice Location Address
First Line : 2970 LORNA RD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35216-4506
Country : US
Telephone Number : 205-981-8900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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Directions to “ ANGIE SMITH PRUETT MS CCC-SLP” Practice Location

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