Healthcare Provider Details

I. General information

NPI: 1700671286
Provider Name (Legal Business Name): JOSETTE M SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 E LONGVIEW DR
APPLETON WI
54911-2130
US

IV. Provider business mailing address

42 BELLEVUE PL
APPLETON WI
54913-7675
US

V. Phone/Fax

Practice location:
  • Phone: 920-277-9461
  • Fax:
Mailing address:
  • Phone: 920-277-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5577-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: