Healthcare Provider Details

I. General information

NPI: 1609846799
Provider Name (Legal Business Name): DONNA MARIE SMITH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N 5TH ST
ELMA WA
98541
US

IV. Provider business mailing address

PO BOX 465
ELMA WA
98541
US

V. Phone/Fax

Practice location:
  • Phone: 360-482-6636
  • Fax: 360-482-6633
Mailing address:
  • Phone: 360-482-6636
  • Fax: 360-482-6633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY00002402
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: