MEDICARE: MRS. JACLYN MERRIMAN SMITH M.C.D., 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	2347	AL

General Provider Information

NPI Number	:	1922318401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACLYN MERRIMAN SMITH M.C.D., CCC-SLP

Provider Business Mailing Address
First Line	:	1050 LAKE COLONY LN
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35242-7405
Country	:	US
Telephone Number	:	205-531-8998
Fax Number	:	205-970-4122

Provider Business Practice Location Address
First Line	:	4229 DOLLY RIDGE RD
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5703
Country	:	US
Telephone Number	:	205-531-8998
Fax Number	:	205-970-4122

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

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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