Provider Demographics
NPI:1770735102
Name:SMITH, JENNIFER BRUNO (MS CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BRUNO
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3119
Mailing Address - Country:US
Mailing Address - Phone:814-931-2170
Mailing Address - Fax:
Practice Address - Street 1:101 LEADER DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1942
Practice Address - Country:US
Practice Address - Phone:570-323-3758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist