Provider Demographics
NPI:1417118654
Name:SMITH, JANIE ELIZABETH (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:ELIZABETH
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2011 CORONA RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2548
Mailing Address - Country:US
Mailing Address - Phone:573-303-5138
Mailing Address - Fax:573-447-4272
Practice Address - Street 1:2011 CORONA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2548
Practice Address - Country:US
Practice Address - Phone:573-303-5138
Practice Address - Fax:573-447-4272
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005022038235Z00000X
IL146.010844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist