Individual
DUSTIN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
128 CHESTNUT AVE # 2, JERSEY CITY, NJ 07306-1418
(973) 460-6533
Mailing address
128 CHESTNUT AVE # 2, JERSEY CITY, NJ 07306-1418
(973) 460-6533
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS01002400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14281343
ASHA-NATIONAL SPEECH LICENSURE-CERTIFICATE OF CLINICAL COMPETENCE
—
01
—
41YS01002400
NEW JERSEY SPEECH LANGUAGE PATHOLOGY LICENSE
NJ
Enumeration date
05/08/2020
Last updated
05/08/2020
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