Basic Information
| Provider Information | |||||||||
| NPI: | 1013068196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 LIVE OAK DR | ||||||||
| Address2: | |||||||||
| City: | COLLEYVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760343256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728419367 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1351 E BARDIN RD STE 160 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760182136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177951291 | ||||||||
| FaxNumber: | 8662088978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 102068 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.