Provider Demographics
NPI:1073863536
Name:SMITH, JERRI HENDRIX (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JERRI
Middle Name:HENDRIX
Last Name:SMITH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LAKE COLONY LANE
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7405
Mailing Address - Country:US
Mailing Address - Phone:205-531-8998
Mailing Address - Fax:205-970-4122
Practice Address - Street 1:4231 DOLLY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-531-8998
Practice Address - Fax:205-970-4122
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-00707OtherBLUE CROSS/BLUE SHIELD