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NPI Code Detail

MEDICARE: KATHRYN MARIE SMITH MS CCC-SLP

MEDICARE: KATHRYN MARIE SMITH 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 Pathologist7869MN

General Provider Information

NPI Number : 1396887493
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN MARIE SMITH MS CCC-SLP
Provider Business Mailing Address
First Line : 208 JEFFERSON CT NE
Second Line :
City : RACINE
State : MN
Zip : 55967-8824
Country : US
Telephone Number : 507-378-5705
Fax Number :
Provider Business Practice Location Address
First Line : 2530 BROADWAY AVE N
Second Line :
City : ROCHESTER
State : MN
Zip : 55906-4594
Country : US
Telephone Number : 507-259-7570
Fax Number : 888-624-3107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 03/17/2018

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Directions to “ KATHRYN MARIE SMITH MS CCC-SLP” Practice Location

Language Start Address Practice Location
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