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General NPI Number Information
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NPI Number | 1023261955
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Entity Type | Individual
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Provider Name | YVONNE SMITH LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 3262 MALLARD COVE LN
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City | FORT WAYNE
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State | IN
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Zip | 46804-2883
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Country | US
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Telephone | 260-580-8508
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Fax | 260-755-1451
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Provider Business Mailing Address
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Address Line | 9331 TIMBER RIDGE CT
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City | FORT WAYNE
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State | IN
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Zip | 46804-7730
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Country | US
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Telephone | 260-580-8508
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Fax | 260-755-1451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005518A
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License Number State | IN
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