Provider Demographics
NPI:1427170711
Name:SMITH, JANICE A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7234
Mailing Address - Country:US
Mailing Address - Phone:360-650-3197
Mailing Address - Fax:360-650-2843
Practice Address - Street 1:WWU, DEPT. OF COMM SCIENCES AND DISORDERS
Practice Address - Street 2:516 HIGH ST
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-9078
Practice Address - Country:US
Practice Address - Phone:360-650-3197
Practice Address - Fax:360-650-2943
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist