Provider Demographics
NPI:1053405332
Name:COON SMITH, JOY M (SLP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:M
Last Name:COON SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 LAGUNA ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2330
Mailing Address - Country:US
Mailing Address - Phone:765-454-5340
Mailing Address - Fax:765-454-5347
Practice Address - Street 1:105 S BENTON ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2560
Practice Address - Country:US
Practice Address - Phone:765-473-6744
Practice Address - Fax:765-472-6058
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002001A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist