Healthcare Provider Details

I. General information

NPI: 1841122181
Provider Name (Legal Business Name): ELIZABETH L SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 4TH ST
MOLINE IL
61265-3707
US

IV. Provider business mailing address

1621 4TH ST
MOLINE IL
61265-3707
US

V. Phone/Fax

Practice location:
  • Phone: 309-798-1356
  • Fax:
Mailing address:
  • Phone: 309-798-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031429
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086007
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: