Individual
MRS. LISA GAYLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
57 RUSSETT LN, PETAL, MS 39465-4061
(601) 270-9464
Mailing address
57 RUSSETT LN, PETAL, MS 39465-4061
(601) 270-9464
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12104093
MS
235Z00000X
Speech-Language Pathologist
193758
MS
235Z00000X
Speech-Language Pathologist
S3064
MS
Other
Enumeration date
01/27/2010
Last updated
02/17/2026
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