Healthcare Provider Details

I. General information

NPI: 1295412013
Provider Name (Legal Business Name): JILLIAN SMITHINGELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MEADOWS DR
GRAYLING MI
49738-2013
US

IV. Provider business mailing address

521 TYLER RD SE
KALKASKA MI
49646-9808
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-8522
  • Fax:
Mailing address:
  • Phone: 231-564-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: