Michael William Gauvin Smith, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12020466 Issued in MA

Practice address

30 Piedmont Ave
Waltham, MA 02451-3013

Phone

(781) 367-0841

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184630400000",
    "number": "1306967682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 PIEDMONT AVE",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024513013",
            "telephone_number": "781-367-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PIEDMONT AVE",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024513013",
            "telephone_number": "781-367-0841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM GAUVIN",
        "name_prefix": "Mr.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "12020466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "5731",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann Elizabeth Smith, M.S., CF-SLP
• Ashley Smith
• Jacqueline Rose Smith
• Jennifer L Smith, CRNA
• Julia Smith, MSW
• Paula J Smith
• Robert James Smith, PH.D.
• Sarah Stollar Smith, CRNP
• Shahara N Smith
• Sharon E Smith, MD

• Speech-Language Pathologist in Waltham, MA
• Providers in Waltham, MA by specialty
• Speech-Language Pathologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.