MEDICARE: SUMMER LYNN SMITH M.S. 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
1	235Z00000X	Speech-Language Pathologist	2995	OK

General Provider Information

NPI Number	:	1073603742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER LYNN SMITH M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	RT 3 BOX 43-D
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-9608
Country	:	US
Telephone Number	:	918-695-5628
Fax Number	:

Provider Business Practice Location Address
First Line	:	RT 3 BOX 43-D
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-9608
Country	:	US
Telephone Number	:	918-695-5628
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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