Provider Demographics
NPI:1861773962
Name:SMITH, JULIANNE KELLEY (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:KELLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2512
Mailing Address - Country:US
Mailing Address - Phone:860-796-7354
Mailing Address - Fax:
Practice Address - Street 1:225 HOPMEADOW ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9782
Practice Address - Country:US
Practice Address - Phone:860-321-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist