Provider Demographics
NPI:1457994212
Name:SMITH, JAMIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 ULUPII ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4444
Mailing Address - Country:US
Mailing Address - Phone:808-447-9122
Mailing Address - Fax:
Practice Address - Street 1:1579 ULUPII ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4444
Practice Address - Country:US
Practice Address - Phone:808-447-9122
Practice Address - Fax:888-769-9120
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5335225100000X
CA221622235Z00000X
HI1823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist