Healthcare Provider Details

I. General information

NPI: 1295647659
Provider Name (Legal Business Name): ALLISON SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 AVIS DR STE 300
ANN ARBOR MI
48108-9517
US

IV. Provider business mailing address

2220 N CLARK ST APT 302
CHICAGO IL
60614-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-961-3030
  • Fax:
Mailing address:
  • Phone: 517-861-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118523
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: