Basic Information
| Provider Information | |||||||||
| NPI: | 1316430416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MARGUERITE | ||||||||
| MiddleName: | REGINA | ||||||||
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| Credential: | M.S., CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4668 PEMBROKE BLVD STE 115 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234556423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576488562 | ||||||||
| FaxNumber: | 7576488564 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 OLD OYSTER POINT RD STE E | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236027177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572231466 | ||||||||
| FaxNumber: | 7572231467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2018 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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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 | 2204000103 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.