Provider Demographics
NPI:1205433992
Name:SMITH, KARLEY JO (MA, CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:KARLEY
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 COUNTY ROAD 438
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB
Mailing Address - State:MO
Mailing Address - Zip Code:64505-3719
Mailing Address - Country:US
Mailing Address - Phone:816-279-4533
Mailing Address - Fax:
Practice Address - Street 1:12401 COUNTY ROAD 438
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB
Practice Address - State:MO
Practice Address - Zip Code:64505-3719
Practice Address - Country:US
Practice Address - Phone:816-279-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020027270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist