Individual provider Active NPI

Victoria S. Smidt, MS, CCC-SLP

  • Speech-Language Pathologist
  • Albuquerque, NM
National Provider Identifier
1124197504
Registry record updated Oct 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
1696 Issued in NM
Practice address
4811 A Hardware Drive NE
Enchantment Speech Language Pathology Services
Albuquerque, NM 87109-2021
Phone
(505) 263-6004
NPI assigned
Nov 7, 2006
Last updated
Oct 12, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 1696 NM Primary

Addresses

Primary practice location

4811 A Hardware Drive NE
Enchantment Speech Language Pathology Services
Albuquerque, NM 87109-2021

Mailing address

16 Juniper Hill Rd NE
Albuquerque, NM 87122-1911
Phone (505) 263-6004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
1696NMMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1124197504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 JUNIPER HILL RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871221911",
            "telephone_number": "505-263-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 A HARDWARE DRIVE NE",
            "address_2": "ENCHANTMENT SPEECH LANGUAGE PATHOLOGY SERVICES",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871092021",
            "telephone_number": "505-263-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMIDT",
        "first_name": "VICTORIA",
        "middle_name": "S.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "1696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.