Provider Demographics
NPI:1831254226
Name:SMANT, JAMIE TUNICK (MHS CF SLP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:TUNICK
Last Name:SMANT
Suffix:
Gender:F
Credentials:MHS CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:715 8TH AVENUE NORTHWEST
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310
Mailing Address - Country:US
Mailing Address - Phone:708-921-5208
Mailing Address - Fax:219-983-9681
Practice Address - Street 1:1120 S CALUMET RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3285
Practice Address - Country:US
Practice Address - Phone:219-983-9675
Practice Address - Fax:219-983-9681
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009039235Z00000X
IN22005584A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist