Healthcare Provider Details

I. General information

NPI: 1659286011
Provider Name (Legal Business Name): JOANN LYNN SMYLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ORCHARD AVE
CLARE MI
48617-8905
US

IV. Provider business mailing address

412 ORCHARD AVE
CLARE MI
48617-8905
US

V. Phone/Fax

Practice location:
  • Phone: 989-544-1048
  • Fax:
Mailing address:
  • Phone: 989-802-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: