Individual
IVA JEAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
823 PHILPOT RD, LOCUST HILL, VA 23092-9746
(804) 758-2496
Mailing address
823 PHILPOT RD, LOCUST HILL, VA 23092-9746
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202007653
VA
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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