Provider Demographics
NPI:1700258662
Name:SMITH, JANEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANEEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 NW 115TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-2707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18441 NW 2ND AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4681
Practice Address - Country:US
Practice Address - Phone:305-810-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14079222Q00000X, 235Z00000X, 251E00000X, 252Y00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016151000Medicaid