| NPI | 1629228515 |
|---|---|
| Former Name | CARLY JEAN SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: IL 147.001294) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: IL 147001294) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2012-01-12 |