Healthcare Provider Details

I. General information

NPI: 1437073442
Provider Name (Legal Business Name): LAURA ASHLEY SMITH LSSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 SHANAHAN RD
LEWIS CENTER OH
43035-9078
US

IV. Provider business mailing address

814 SHANAHAN RD
LEWIS CENTER OH
43035-9078
US

V. Phone/Fax

Practice location:
  • Phone: 740-657-5046
  • Fax: 740-657-4696
Mailing address:
  • Phone: 740-657-5046
  • Fax: 740-657-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: