Provider Demographics
NPI:1447628474
Name:SMOLL, CIELITO MARIE DEROMOL
Entity type:Individual
Prefix:
First Name:CIELITO MARIE
Middle Name:DEROMOL
Last Name:SMOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:
Other - Last Name:SMOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18230 E MEWS RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7349
Mailing Address - Country:US
Mailing Address - Phone:480-202-3178
Mailing Address - Fax:
Practice Address - Street 1:15701 E 1ST AVE STE 206
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9038
Practice Address - Country:US
Practice Address - Phone:303-344-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2355S0801X
CO24399506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant