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General NPI Number Information
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NPI Number | 1518291608
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Entity Type | Individual
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Provider Name | JONATHAN SMITH
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Gender | Male
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 545 ROWLETT RD
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City | GARLAND
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State | TX
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Zip | 75043-3700
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Country | US
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Telephone | 214-547-1571
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 W CAMPBELL RD #434
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City | GARLAND
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State | TX
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Zip | 75044-2923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 34481
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License Number State | TX
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