Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3726 | WI |
Y | 103T00000X | Psychologist | 3726 | WI |
NPI | 1003394784 |
---|---|
Provider Name | Brianna A Smith |
First Address | Milwaukee, WI 53215-2843 |
Second Address | West Allis, WI 53227-2455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2018 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100080246 | (05) | WI |