Provider Demographics
NPI:1568508364
Name:SMITH, JAKE ASHTON
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:ASHTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 COUNTY CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965
Mailing Address - Country:US
Mailing Address - Phone:530-538-7395
Mailing Address - Fax:
Practice Address - Street 1:5910 CLARK ROAD
Practice Address - Street 2:SUITES H AND I
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969
Practice Address - Country:US
Practice Address - Phone:530-872-6325
Practice Address - Fax:530-872-5970
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor