MEDICARE: CALIE MAE 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	2355S0801X	Speech-Language Assistant	SLPA15042	AZ

General Provider Information

NPI Number	:	1356104665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALIE MAE SMITH

Provider Business Mailing Address
First Line	:	155 S PARKCREST ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-2163
Country	:	US
Telephone Number	:	407-414-2792
Fax Number	:

Provider Business Practice Location Address
First Line	:	3012 N 17TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-6112
Country	:	US
Telephone Number	:	480-824-8889
Fax Number	:

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

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Directions to “ CALIE MAE SMITH ” Practice Location

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