MEDICARE: CYNTHIA LOUISE 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	2202000527	VA

General Provider Information

NPI Number	:	1295921260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LOUISE SMITH

Provider Business Mailing Address
First Line	:	5427 LEEWAY CT
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-3313
Country	:	US
Telephone Number	:	703-425-7744
Fax Number	:

Provider Business Practice Location Address
First Line	:	12806 FALCON WOOD PL
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2239
Country	:	US
Telephone Number	:	703-425-7744
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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Directions to “ CYNTHIA LOUISE SMITH ” Practice Location

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