Provider Demographics
NPI:1316192479
Name:SMITH, JOSHUA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WINDSOR POND RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3278
Mailing Address - Country:US
Mailing Address - Phone:917-903-3832
Mailing Address - Fax:609-799-6772
Practice Address - Street 1:113 WINDSOR POND RD
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-3278
Practice Address - Country:US
Practice Address - Phone:917-903-3832
Practice Address - Fax:609-799-6772
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010789-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist