Provider Demographics
NPI:1255976700
Name:SMYERS, JENNA LYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYN
Last Name:SMYERS
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 1:4119 W DRESDEN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-8404
Mailing Address - Country:US
Mailing Address - Phone:610-248-8061
Mailing Address - Fax:
Practice Address - Street 1:4119 W DRESDEN DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-8404
Practice Address - Country:US
Practice Address - Phone:610-248-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist