Healthcare Provider Details

I. General information

NPI: 1003856626
Provider Name (Legal Business Name): MARGARET SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 OFFICERS ROW
VANCOUVER WA
98661-3849
US

IV. Provider business mailing address

955 OFFICERS ROW
VANCOUVER WA
98661-3849
US

V. Phone/Fax

Practice location:
  • Phone: 360-213-7893
  • Fax:
Mailing address:
  • Phone: 360-213-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY00001404
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: