Provider Demographics
NPI:1669659157
Name:SMITH, JENNIFER KROOHS (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KROOHS
Last Name:SMITH
Suffix:
Gender:F
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 1:107 THENSIA CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4251
Mailing Address - Country:US
Mailing Address - Phone:919-280-3639
Mailing Address - Fax:
Practice Address - Street 1:107 THENSIA CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4251
Practice Address - Country:US
Practice Address - Phone:919-280-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-27
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist