MEDICARE: MS. YVONNE SMITH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34005518A	IN

General Provider Information

NPI Number	:	1023261955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YVONNE SMITH LCSW

Provider Business Mailing Address
First Line	:	9331 TIMBER RIDGE CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7730
Country	:	US
Telephone Number	:	260-580-8508
Fax Number	:	260-755-1451

Provider Business Practice Location Address
First Line	:	3262 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2883
Country	:	US
Telephone Number	:	260-580-8508
Fax Number	:	260-755-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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