MEDICARE: VIRGINIA 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	6314	LA

General Provider Information

NPI Number	:	1437578093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA SMITH

Provider Business Mailing Address
First Line	:	1 BAMBOO RD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-1007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BAMBOO RD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-1007
Country	:	US
Telephone Number	:	504-452-3504
Fax Number	:

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

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/10/2014

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Directions to “ VIRGINIA SMITH ” Practice Location

Language	Start Address	Practice Location

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