MEDICARE: MRS. JERRI HENDRIX SMITH MCD, 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	922	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	510-00707	OTHER	AL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1073863536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JERRI HENDRIX SMITH MCD, CCC-SLP

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

Provider Business Practice Location Address
First Line	:	4231 DOLLY RIDGE ROAD
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35243
Country	:	US
Telephone Number	:	205-531-8998
Fax Number	:	205-970-4122

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

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	09/12/2012

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Directions to “ MRS. JERRI HENDRIX SMITH MCD, CCC-SLP” Practice Location

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