MEDICARE: MELISSA SMYSER M.S.W, L.M.S.W

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	2011035684	MO

General Provider Information

NPI Number	:	1659640910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SMYSER M.S.W, L.M.S.W

Provider Business Mailing Address
First Line	:	409 VANDIVER DR
Second Line	:	BUILDING 5 STE 203
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3754
Country	:	US
Telephone Number	:	573-442-9916
Fax Number	:	573-442-9915

Provider Business Practice Location Address
First Line	:	409 VANDIVER DR
Second Line	:	BUILDING 5 STE 203
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3754
Country	:	US
Telephone Number	:	573-442-9916
Fax Number	:	573-442-9915

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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