Provider Demographics
NPI:1275679862
Name:SMITH, JADA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:
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 1:23026 LAWRENCE 1200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-8252
Mailing Address - Country:US
Mailing Address - Phone:417-818-6606
Mailing Address - Fax:
Practice Address - Street 1:700 E CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1436
Practice Address - Country:US
Practice Address - Phone:417-236-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist