Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003211855 |
---|---|
Provider Name | Janelle Smolen |
First Address | Moorhead, MN 56560-5055 |
Second Address | Moorhead, MN 56560-5055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2014 |
Last Update Date | 13/02/2017 |