Provider Demographics
NPI:1841710860
Name:SMITH, JOANNA LEIGH (MS, SLP/L)
Entity type:Individual
Prefix:MISS
First Name:JOANNA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MANNING ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4422
Mailing Address - Country:US
Mailing Address - Phone:814-441-3182
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1874
Practice Address - Country:US
Practice Address - Phone:800-244-2756
Practice Address - Fax:800-244-2756
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76547-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist