MEDICARE: CHRISTINA JANAY SMITH

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
1	235Z00000X	Speech-Language Pathologist	39254	TX

General Provider Information

NPI Number	:	1053048512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA JANAY SMITH

Provider Business Mailing Address
First Line	:	1700 9TH AVE N
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-5470
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 13TH AVE N
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-5498
Country	:	US
Telephone Number	:	409-916-0512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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Directions to “ CHRISTINA JANAY SMITH ” Practice Location

Language	Start Address	Practice Location

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