Healthcare Provider Details

I. General information

NPI: 1881109429
Provider Name (Legal Business Name): MISTY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BIEDE AVE
DEFIANCE OH
43512-2408
US

IV. Provider business mailing address

937 WASHINGTON AVE
DEFIANCE OH
43512-2820
US

V. Phone/Fax

Practice location:
  • Phone: 419-782-8856
  • Fax: 419-784-4506
Mailing address:
  • Phone: 419-576-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2506541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: