Provider Demographics
NPI:1770892614
Name:SMITH, JULIE PORTH (MCD, CCC-SLP, ATP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:PORTH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 DAILEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-7882
Mailing Address - Country:US
Mailing Address - Phone:803-260-6295
Mailing Address - Fax:
Practice Address - Street 1:763 DAILEY CREEK RD
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-7882
Practice Address - Country:US
Practice Address - Phone:803-260-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist