Healthcare Provider Details

I. General information

NPI: 1568308658
Provider Name (Legal Business Name): PAYTON MONIQUE MARIE SMITH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 N NORTHWEST HWY #120
PARK RIDGE IL
60068
US

IV. Provider business mailing address

1580 N NORTHWEST HWY #120
PARK RIDGE IL
60068
US

V. Phone/Fax

Practice location:
  • Phone: 847-220-4977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150119400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: