Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6802087488 | MI |
NPI | 1003206889 |
---|---|
Provider Name | Karrie Smith |
First Address | Wyoming, MI 49548-2251 |
Second Address | Wyoming, MI 49548-2251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2015 |
Last Update Date | 30/01/2015 |