Provider Demographics
NPI:1720202393
Name:SMITH, JAN OSOINACH
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:OSOINACH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HIGHLAND PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5635
Mailing Address - Country:US
Mailing Address - Phone:225-769-0462
Mailing Address - Fax:
Practice Address - Street 1:535 WEST ROOSEVELT STREET
Practice Address - Street 2:
Practice Address - City:BATONROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-7899
Practice Address - Country:US
Practice Address - Phone:225-343-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist