Provider Demographics
NPI:1366883563
Name:SMITH, AUBREY LAURA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:LAURA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 E VALLEY WATER MILL RD
Mailing Address - Street 2:APT 5601
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4908
Mailing Address - Country:US
Mailing Address - Phone:641-590-1366
Mailing Address - Fax:
Practice Address - Street 1:3126 E VALLEY WATER MILL RD
Practice Address - Street 2:APT 5601
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4908
Practice Address - Country:US
Practice Address - Phone:641-590-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010024543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist