Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2018036326 | MO |
NPI | 1003270950 |
---|---|
Provider Name | Mrs. Chelsea Smithson |
First Address | Wentzville, MO 63385-3421 |
Second Address | Wentzville, MO 63385-3421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 01/02/2019 |