Individual
MR. MICHAEL WILLIAM GAUVIN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, CCC-SLP
Contact information
Practice address
30 PIEDMONT AVE, WALTHAM, MA 02451-3013
(781) 367-0841
Mailing address
30 PIEDMONT AVE, WALTHAM, MA 02451-3013
(781) 367-0841
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12020466
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5731
BLUE CROSS AND BLUE SHIEL
MA
Enumeration date
04/03/2007
Last updated
07/17/2007
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