Provider Demographics
NPI:1144464181
Name:SMIGELSKI, CARRIE JANE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JANE
Last Name:SMIGELSKI
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:JANE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8514 W GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8120
Mailing Address - Country:US
Mailing Address - Phone:509-735-6442
Mailing Address - Fax:
Practice Address - Street 1:8514 W GAGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8120
Practice Address - Country:US
Practice Address - Phone:509-735-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60024943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist