Provider Demographics
NPI:1619383932
Name:SMITH, ALISON MARIE (CF-SLP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 75TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7925
Mailing Address - Country:US
Mailing Address - Phone:630-236-7000
Mailing Address - Fax:
Practice Address - Street 1:3965 75TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7925
Practice Address - Country:US
Practice Address - Phone:630-236-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist