MEDICARE: MICHELLE SMITH BCBA

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	103K00000X	Behavior Analyst	152.002790	IL

General Provider Information

NPI Number	:	1881128841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SMITH BCBA

Provider Business Mailing Address
First Line	:	4027 EUCLID AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2838
Country	:	US
Telephone Number	:	857-999-5143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4027 EUCLID AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2838
Country	:	US
Telephone Number	:	857-999-5143
Fax Number	:

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

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	03/09/2026

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