MEDICARE: JOANNA SMITH MA LMFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1275875452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA SMITH MA LMFT

Provider Business Mailing Address
First Line	:	4660 SLATER RD STE 210
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55122-4055
Country	:	US
Telephone Number	:	651-882-6299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 SLATER RD STE 210
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55122-4055
Country	:	US
Telephone Number	:	651-882-6299
Fax Number	:

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

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	10/31/2019

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