Individual
MS. TAMARA JANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2945 2ND AVE E, BIG STONE GAP, VA 24219-3801
(276) 523-4900
Mailing address
628 LAKE ST NE, WISE, VA 24293-7919
(276) 328-8017
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2203000329
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2203000329
—
VA
Enumeration date
01/03/2018
Last updated
01/03/2018
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