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General NPI Number Information
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NPI Number | 1417021999
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Entity Type | Individual
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Provider Name | JENNIFER ANN SMITH M.ED., PCC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 453 ALLENBY DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-8722
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Country | US
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Telephone | 937-642-0048
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Fax | 937-642-1316
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Provider Business Mailing Address
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Address Line | 5592 CRAWFORD DR
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City | COLUMBUS
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State | OH
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Zip | 43229-4176
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Country | US
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Telephone | 614-846-6597
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E 0501056
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License Number State | OH
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