Individual
JEAN D SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
313 LUCAS ST E, CASTALIA, OH 44824-9782
(419) 901-0816
Mailing address
313 LUCAS ST E, CASTALIA, OH 44824-9782
(419) 901-0816
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-1223
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11589618
CAQH
OH
Enumeration date
07/06/2006
Last updated
11/12/2014
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