Healthcare Provider Details

I. General information

NPI: 1588579536
Provider Name (Legal Business Name): LILLIANNA MAGDALINE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11530 ALLISONVILLE RD
FISHERS IN
46038-1866
US

IV. Provider business mailing address

6852 ALNWICK CT
INDIANAPOLIS IN
46220-4304
US

V. Phone/Fax

Practice location:
  • Phone: 317-742-9730
  • Fax:
Mailing address:
  • Phone: 317-775-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: