Provider Demographics
NPI:1376571224
Name:SMITH, JO DEE (NON AID)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:DEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NON AID
Other - Prefix:MRS
Other - First Name:JO
Other - Middle Name:DEE
Other - Last Name:LEAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2299 WINTER PKWY
Mailing Address - Street 2:APT # 277
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3768
Mailing Address - Country:US
Mailing Address - Phone:330-622-4210
Mailing Address - Fax:
Practice Address - Street 1:2299 WINTER PKWY
Practice Address - Street 2:APT # 277
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3768
Practice Address - Country:US
Practice Address - Phone:330-622-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH2145619374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH773106734901Medicaid
OH103293964599Medicaid