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General NPI Number Information
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NPI Number | 1275091910
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Entity Type | Individual
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Provider Name | SYDNI SMITH
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Gender | Female
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 3140 DUSTIN RD STE 1
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City | OREGON
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State | OH
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Zip | 43616-4341
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Country | US
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Telephone | 567-218-0185
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Fax | 419-930-6721
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Provider Business Mailing Address
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Address Line | 615 KINGSBURY ST
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City | MAUMEE
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State | OH
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Zip | 43537-1865
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Country | US
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Telephone | 567-218-0185
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Fax | 419-930-6721
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.2405464
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2405464
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License Number State | OH
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