Basic Information
| Provider Information | |||||||||
| NPI: | 1457312316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 834 W 4 ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192344360 | ||||||||
| FaxNumber: | 3192355360 | ||||||||
| Practice Location | |||||||||
| Address1: | 834 W 4 ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192344360 | ||||||||
| FaxNumber: | 3192355360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 03/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 00483 | IA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.