Provider Demographics
NPI:1356523708
Name:SMIDY, JENNIFER P
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:SMIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:P
Other - Last Name:GIROUARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 FORTUNE BLVD.
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-478-0207
Mailing Address - Fax:508-634-6984
Practice Address - Street 1:321 FORTUNE BLVD.
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-478-0207
Practice Address - Fax:508-634-6984
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency