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General NPI Number Information
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NPI Number | 1215206552
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Entity Type | Individual
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Provider Name | NICOLE LYNN SMITH PSY.D., L.P.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 10273 YELLOW CIRCLE DR
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City | MINNETONKA
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State | MN
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Zip | 55343-9144
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Country | US
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Telephone | 952-215-3759
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Fax | 952-401-9805
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Provider Business Mailing Address
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Address Line | 2841 BRYANT AVE S APT 130
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4896
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Country | US
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Telephone | 414-232-7277
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Fax |
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | LP5504
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License Number State | MN
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