MEDICARE: COURTNEY MARIE SMITH M.S., 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	07-020	KY

General Provider Information

NPI Number	:	1821219601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MARIE SMITH M.S., SLP

Provider Business Mailing Address
First Line	:	9212 WOODDALE DRIVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272
Country	:	US
Telephone Number	:	502-935-3794
Fax Number	:

Provider Business Practice Location Address
First Line	:	3222 ROLLING OAK BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KS
Zip	:	40214
Country	:	US
Telephone Number	:	502-386-8509
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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