MEDICARE: KELLY ANN SMITH ARICKX

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	104100000X	Social Worker	04878	IA

General Provider Information

NPI Number	:	1619637246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN SMITH ARICKX

Provider Business Mailing Address
First Line	:	705 N MAIN ST STE 2
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-2125
Country	:	US
Telephone Number	:	641-715-1183
Fax Number	:	641-715-1184

Provider Business Practice Location Address
First Line	:	705 N MAIN ST STE 2
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-2125
Country	:	US
Telephone Number	:	641-715-1183
Fax Number	:	641-715-1184

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

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	12/22/2021

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Directions to “ KELLY ANN SMITH ARICKX ” Practice Location

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