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NPI Code Detail

MEDICARE: HAILEY DEANN SMITH

MEDICARE: HAILEY DEANN SMITH
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1528687548
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY DEANN SMITH
Provider Business Mailing Address
First Line : 9314 FREEDOM RD UNIT 528
Second Line :
City : SAPULPA
State : OK
Zip : 74066-2184
Country : US
Telephone Number : 817-233-1085
Fax Number :
Provider Business Practice Location Address
First Line : 401 S DEWEY AVE STE 108
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74003-3525
Country : US
Telephone Number : 918-336-0810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2020
Last Update Date : 04/09/2020

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Directions to “ HAILEY DEANN SMITH ” Practice Location

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