Provider Demographics
NPI:1902035355
Name:SMITH, CONSTANCE CHERYL (MS, MED)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:CHERYL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 AZALEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 AZALEA DRIVE
Practice Address - Street 2:
Practice Address - City:NEW ALANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-949-1518
Practice Address - Fax:812-949-1518
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01009441235Z00000X
IN0100-9441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist