Basic Information
| Provider Information | |||||||||
| NPI: | 1609323211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DEIRDRE | ||||||||
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| Credential: | M.S. SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3212 WHITEMAN RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198082720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025476055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 CORPORATE CIRCLE | ||||||||
| Address2: | EASTER SEALS DE & MD | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023244444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | O4-0000502 | DE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.