Provider Demographics
NPI:1922318401
Name:SMITH, JACLYN MERRIMAN (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MERRIMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LAKE COLONY LN
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7405
Mailing Address - Country:US
Mailing Address - Phone:205-531-8998
Mailing Address - Fax:205-970-4122
Practice Address - Street 1:4229 DOLLY RIDGE RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5703
Practice Address - Country:US
Practice Address - Phone:205-531-8998
Practice Address - Fax:205-970-4122
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist