Provider Demographics
NPI:1649660085
Name:SMITH, KALEENA DANIELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KALEENA
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 NECTAR CT
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-9206
Mailing Address - Country:US
Mailing Address - Phone:615-270-8745
Mailing Address - Fax:931-444-5588
Practice Address - Street 1:948 NECTAR CT
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:TN
Practice Address - Zip Code:37010-9206
Practice Address - Country:US
Practice Address - Phone:615-270-8745
Practice Address - Fax:931-444-5588
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 3870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ057692Medicaid