MEDICARE: DEENNA SMITH PSS

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	175T00000X	Peer Specialist	19424	MO

General Provider Information

NPI Number	:	1558152124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEENNA SMITH PSS

Provider Business Mailing Address
First Line	:	PO BOX 300038
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-0327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5620 JENNINGS STATION RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-3537
Country	:	US
Telephone Number	:	314-745-7919
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/23/2025

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Directions to “ DEENNA SMITH PSS” Practice Location

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