Provider Demographics
NPI:1013328707
Name:SMITH, JESSICA JEANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JEANNE
Other - Last Name:MIRT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:4561 WESTLAKE CT.
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220
Mailing Address - Country:US
Mailing Address - Phone:316-304-5303
Mailing Address - Fax:316-634-8850
Practice Address - Street 1:4561 WESTLAKE CT.
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67220
Practice Address - Country:US
Practice Address - Phone:316-304-5303
Practice Address - Fax:316-634-8850
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK01754066235Z00000X
KS3792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist