Provider Demographics
NPI:1962914275
Name:SMITH-WILLIAMS, LA JANNELLE (MS, SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:LA JANNELLE
Middle Name:
Last Name:SMITH-WILLIAMS
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43940 21ST ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-8215
Mailing Address - Country:US
Mailing Address - Phone:661-317-9318
Mailing Address - Fax:
Practice Address - Street 1:190 SIERRA CT STE B6
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7608
Practice Address - Country:US
Practice Address - Phone:661-317-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist