Provider Demographics
NPI:1073010716
Name:SMITH, JERRICA
Entity Type:Individual
Prefix:
First Name:JERRICA
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 1:271 ROCKINGHAM MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6709
Mailing Address - Country:US
Mailing Address - Phone:423-557-3757
Mailing Address - Fax:
Practice Address - Street 1:271 ROCKINGHAM MEADOWS DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-6709
Practice Address - Country:US
Practice Address - Phone:423-557-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist