Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 11081 | IA |
NPI | 1003278193 |
---|---|
Provider Name | Roxann Smith |
First Address | Sioux City, IA 51101-1317 |
Second Address | Sioux City, IA 51101-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 28/03/2016 |