Provider Demographics
NPI:1104297282
Name:SMITH, JODY (CLC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:MARSHALL-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 NE 1ST AVE
Mailing Address - Street 2:APT H2112
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4106
Mailing Address - Country:US
Mailing Address - Phone:305-764-9616
Mailing Address - Fax:
Practice Address - Street 1:3301 NE 1ST AVE
Practice Address - Street 2:APT H2112
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4106
Practice Address - Country:US
Practice Address - Phone:305-764-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN