Provider Demographics
NPI:1730249202
Name:SMITH, DINAH KAY (MA)
Entity type:Individual
Prefix:MS
First Name:DINAH
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF VERMONT
Mailing Address - Street 2:489 MAIN STREET POMEROY HALL
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-0130
Mailing Address - Country:US
Mailing Address - Phone:802-656-3861
Mailing Address - Fax:802-656-2528
Practice Address - Street 1:UNIVERSITY OF VERMONT
Practice Address - Street 2:489 MAIN STREET POMEROY HALL
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-0130
Practice Address - Country:US
Practice Address - Phone:802-656-3861
Practice Address - Fax:802-656-2528
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT00810242231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002779Medicaid
2779OtherBLUE CROSS BLUE SHIELD
04V035OtherMVP