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General NPI Number Information
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NPI Number | 1942666045
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Entity Type | Individual
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Provider Name | OLIVIA L SMITH BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 12075 CORPORATE PKWY STE 110
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City | MEQUON
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State | WI
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Zip | 53092-2664
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Country | US
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Telephone | 877-486-4140
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Fax | 847-486-4145
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Provider Business Mailing Address
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Address Line | 950 LEE ST SUITE 210
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City | DES PLAINES
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State | IL
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Zip | 60016-6532
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Country | US
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Telephone | 877-486-4140
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Fax | 847-486-4145
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15-19887
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License Number State | IL
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