Provider Demographics
NPI:1639060023
Name:SMITH, CAILLIE (SLP)
Entity type:Individual
Prefix:
First Name:CAILLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 FAIRYSTONE PARK HWY
Mailing Address - Street 2:
Mailing Address - City:STANLEYTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:24168-3014
Mailing Address - Country:US
Mailing Address - Phone:276-622-3636
Mailing Address - Fax:276-627-0060
Practice Address - Street 1:935 FAIRYSTONE PARK HWY
Practice Address - Street 2:
Practice Address - City:STANLEYTOWN
Practice Address - State:VA
Practice Address - Zip Code:24168-3014
Practice Address - Country:US
Practice Address - Phone:276-622-3636
Practice Address - Fax:276-627-0060
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001565235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist