Healthcare Provider Details

I. General information

NPI: 1225387517
Provider Name (Legal Business Name): ANDREA LEBERT-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2012
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S WESTWOOD DR
ISHPEMING MI
49849-2922
US

IV. Provider business mailing address

417 W CRESCENT ST
MARQUETTE MI
49855-3313
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-1021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000506
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: