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General NPI Number Information
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NPI Number | 1184958258
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Entity Type | Individual
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Provider Name | JODI MICHELLE SMITH-COHEN LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 2956 CENTRAL ST
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City | EVANSTON
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State | IL
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Zip | 60201-1246
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Country | US
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Telephone | 847-217-1657
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Fax | 847-933-9703
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Provider Business Mailing Address
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Address Line | 9550 CENTRAL PARK AVE
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City | EVANSTON
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State | IL
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Zip | 60203-1104
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Country | US
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Telephone | 847-217-1657
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Fax | 847-933-9708
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000768
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License Number State | IL
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