MEDICARE: LAKEYA SMITH CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	015836-1	NY
2	235Z00000X	Speech-Language Pathologist	41YS00328200	NJ

General Provider Information

NPI Number	:	1558514869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKEYA SMITH CCC-SLP

Provider Business Mailing Address
First Line	:	346 DUVIER PL
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1111
Country	:	US
Telephone Number	:	973-979-2331
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 W PASSAIC ST STE 3
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1264
Country	:	US
Telephone Number	:	973-979-2331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	11/11/2022

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Directions to “ LAKEYA SMITH CCC-SLP” Practice Location

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