Healthcare Provider Details

I. General information

NPI: 1780641977
Provider Name (Legal Business Name): JOLENE RAE SMAAGE MA, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 HEBRON RD
HEATH OH
43056-1402
US

IV. Provider business mailing address

PO BOX 22
GRANVILLE OH
43023-0022
US

V. Phone/Fax

Practice location:
  • Phone: 740-334-1823
  • Fax: 740-587-3657
Mailing address:
  • Phone: 740-334-1823
  • Fax: 740-587-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC8224
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: