MEDICARE: DR. SUZANNE L. SMITLEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3744	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134197494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE L. SMITLEY PH.D.

Provider Business Mailing Address
First Line	:	4841 MONROE ST
Second Line	:	SUITE 100
City	:	TOLEDO
State	:	OH
Zip	:	43623-4385
Country	:	US
Telephone Number	:	419-475-2535
Fax Number	:	419-475-0881

Provider Business Practice Location Address
First Line	:	4841 MONROE ST
Second Line	:	SUITE 100
City	:	TOLEDO
State	:	OH
Zip	:	43623-4385
Country	:	US
Telephone Number	:	419-475-2535
Fax Number	:	419-475-0881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	10/19/2011

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