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General NPI Number Information
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NPI Number | 1891842001
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Entity Type | Individual
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Provider Name | JENNIFER SMITH ALLSWEDE PHD
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 411 W LAKE LANSING RD
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City | EAST LANSING
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State | MI
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Zip | 48823-8445
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Country | US
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Telephone | 517-336-7366
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Fax | 517-336-0808
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Provider Business Mailing Address
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Address Line | PO BOX 4455
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City | EAST LANSING
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State | MI
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Zip | 48826-4455
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Country | US
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Telephone | 517-336-7366
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301008335
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License Number State | MI
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