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General NPI Number Information
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NPI Number | 1841321486
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Entity Type | Individual
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Provider Name | THERESA J SMITH MSW,PLCSW
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1119 S ELLIOTT AVE
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City | AURORA
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State | MO
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Zip | 65605-2405
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Country | US
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Telephone | 417-235-9936
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Fax |
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Provider Business Mailing Address
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Address Line | 21102 LAWRENCE 1165
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City | VERONA
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State | MO
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Zip | 65769-6282
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Country | US
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Telephone | 417-235-9936
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20060348492
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License Number State | MO
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