Provider Demographics
NPI:1215814595
Name:SMITH, JUSTIS
Entity type:Individual
Prefix:
First Name:JUSTIS
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 US HWY 1
Mailing Address - Street 2:
Mailing Address - City:BARING PLT
Mailing Address - State:ME
Mailing Address - Zip Code:04694-5003
Mailing Address - Country:US
Mailing Address - Phone:207-952-0597
Mailing Address - Fax:
Practice Address - Street 1:79 US HWY 1
Practice Address - Street 2:
Practice Address - City:BARING PLT
Practice Address - State:ME
Practice Address - Zip Code:04694-5003
Practice Address - Country:US
Practice Address - Phone:207-952-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist