Provider Demographics
NPI:1841300043
Name:SMITH, JOAN M (EDD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401 ROLAND CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-9303
Mailing Address - Country:US
Mailing Address - Phone:831-484-0994
Mailing Address - Fax:831-484-0998
Practice Address - Street 1:1900 GARDEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5373
Practice Address - Country:US
Practice Address - Phone:831-375-1863
Practice Address - Fax:831-484-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 2103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 2103OtherSPEECH PATHOLOGY LICENSE