Basic Information
| Provider Information | |||||||||
| NPI: | 1154736411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 WILDWOOD ROAD | ||||||||
| Address2: | |||||||||
| City: | GIBSONIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124877771 | ||||||||
| FaxNumber: | 4154877772 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 WILLIAM PENN HWY | ||||||||
| Address2: | |||||||||
| City: | MURRYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156681870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245197722 | ||||||||
| FaxNumber: | 7245192910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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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 | SP-1718 | NV | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 103049750-0001 | 05 | PA | MEDICAID | 103049750-0002 | 05 | PA | MEDICAID |