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General NPI Number Information
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NPI Number | 1689899965
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Entity Type | Individual
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Provider Name | JENNIFER SUSANNE SMITH PCC, LICDC
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Gender | Female
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3454 OAK ALLEY CT SUITE 404
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City | TOLEDO
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State | OH
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Zip | 43606-1306
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Country | US
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Telephone | 419-531-3337
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Fax | 419-531-3302
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Provider Business Mailing Address
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Address Line | 2611 SCOTTWOOD AVE
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City | TOLEDO
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State | OH
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Zip | 43610-1324
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Country | US
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Telephone | 419-509-6592
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Fax | 419-244-5794
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.0004340
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License Number State | OH
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