Basic Information
| Provider Information | |||||||||
| NPI: | 1831254226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMANT | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | TUNICK | ||||||||
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| Credential: | MHS CF SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 8TH AVENUE NORTHWEST | ||||||||
| Address2: | |||||||||
| City: | DEMOTTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089215208 | ||||||||
| FaxNumber: | 2199839681 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 S CALUMET RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463043285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199839675 | ||||||||
| FaxNumber: | 2199839681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146.009039 | IL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 22005584A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.