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NPI Code Detail

MEDICARE: JENNIFER MARTA SMITH MS, CCC-SLP

MEDICARE: JENNIFER MARTA SMITH MS, 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
1235Z00000XSpeech-Language Pathologist2202008911VA

General Provider Information

NPI Number : 1770842031
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARTA SMITH MS, CCC-SLP
Provider Business Mailing Address
First Line : 1340 BRADDOCK PL
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-1693
Country : US
Telephone Number : 301-619-8139
Fax Number :
Provider Business Practice Location Address
First Line : 1340 BRADDOCK PL
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-1693
Country : US
Telephone Number : 301-619-8139
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2012
Last Update Date : 03/04/2020

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