Healthcare Provider Details

I. General information

NPI: 1679342521
Provider Name (Legal Business Name): KELLIE SMITH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E WALNUT ST
LANCASTER OH
43130-4464
US

IV. Provider business mailing address

220 E WALNUT ST
LANCASTER OH
43130-4464
US

V. Phone/Fax

Practice location:
  • Phone: 740-277-6043
  • Fax: 740-277-7595
Mailing address:
  • Phone: 740-277-6043
  • Fax: 740-277-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512485
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: