Provider Demographics
NPI:1316145949
Name:SMOLEN, PATRICIA JO (SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JO
Last Name:SMOLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:JO
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:5022 OLD GODSEY LN
Practice Address - Street 2:SUITE 3
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6600
Practice Address - Country:US
Practice Address - Phone:423-870-3573
Practice Address - Fax:423-870-3574
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3156797OtherBCBS GROUP #
TN0446652Medicaid
TN3156797OtherBCBS GROUP #