Healthcare Provider Details

I. General information

NPI: 1417630898
Provider Name (Legal Business Name): DANIELLE SMITH LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 SE BAYSHORE DR
OAK HARBOR WA
98277-5700
US

IV. Provider business mailing address

4656 MONKEY HILL RD
OAK HARBOR WA
98277-9761
US

V. Phone/Fax

Practice location:
  • Phone: 360-334-7339
  • Fax:
Mailing address:
  • Phone: 360-334-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: