Provider Demographics
NPI:1982002424
Name:SMITH, JADE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2532
Mailing Address - Country:US
Mailing Address - Phone:816-853-4737
Mailing Address - Fax:
Practice Address - Street 1:925 FELIX ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2706
Practice Address - Country:US
Practice Address - Phone:816-671-4000
Practice Address - Fax:816-671-4013
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MO2014036850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist