Provider Demographics
NPI:1588628994
Name:SMITH, JUDITH ANN (CCC A)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010
Mailing Address - Country:US
Mailing Address - Phone:515-233-1367
Mailing Address - Fax:515-233-1012
Practice Address - Street 1:118 E 13TH ST
Practice Address - Street 2:HEARING UNLIMITED
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010
Practice Address - Country:US
Practice Address - Phone:515-233-1367
Practice Address - Fax:515-233-1012
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251231H00000X
IA126237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0027821Medicaid
IA59208Medicare ID - Type Unspecified
IA0027821Medicaid