Healthcare Provider Details

I. General information

NPI: 1922929306
Provider Name (Legal Business Name): KADIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S 4TH ST
ROSCOMMON MI
48653-8904
US

IV. Provider business mailing address

112 S 4TH ST
ROSCOMMON MI
48653-8904
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-7145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851122491
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: