Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 1316 | WY |
NPI | 1003252289 |
---|---|
Provider Name | Deiadra Louise Smidt |
First Address | Sheridan, WY 82801-5755 |
Second Address | Sheridan, WY 82801-5755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 15/05/2013 |