Provider Demographics
NPI:1871916346
Name:SMITH, NATALIE BROOKE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:BROOKE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 OLD PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2865
Mailing Address - Country:US
Mailing Address - Phone:706-364-3470
Mailing Address - Fax:706-496-7789
Practice Address - Street 1:3624 OLD PETERSBURG RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2865
Practice Address - Country:US
Practice Address - Phone:706-364-3470
Practice Address - Fax:706-496-7789
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist