Healthcare Provider Details

I. General information

NPI: 1417073479
Provider Name (Legal Business Name): BARBARA ANN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR STE B
VANCOUVER WA
98662-6347
US

IV. Provider business mailing address

195 COPPER CREEK RD
WOODLAND WA
98674-8303
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax:
Mailing address:
  • Phone: 360-225-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00049763
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: