Provider Demographics
NPI:1952875700
Name:SMOLA, JASMINE ALEXIS (SLP)
Entity Type:Individual
Prefix:MISS
First Name:JASMINE
Middle Name:ALEXIS
Last Name:SMOLA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W ELLIOT RD STE 109
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1310
Mailing Address - Country:US
Mailing Address - Phone:480-374-4341
Mailing Address - Fax:480-374-4343
Practice Address - Street 1:1 W ELLIOT RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1310
Practice Address - Country:US
Practice Address - Phone:480-374-4341
Practice Address - Fax:480-374-4343
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
AZTSLP11648235Z00000X
AZSLP11648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant