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General NPI Number Information
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NPI Number | 1073285870
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Entity Type | Individual
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Provider Name | KATIE JEANNE SMITH MA, LADC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 2217 NICOLLET AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-3382
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Country | US
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Telephone | 612-767-0319
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Fax | 612-870-3796
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Provider Business Mailing Address
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Address Line | 10450 GRAND OAKS TRL
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City | WOODBURY
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State | MN
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Zip | 55129-4241
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Country | US
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Telephone | 507-381-8165
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Fax | 612-879-3796
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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