MEDICARE: BETH SMETANA LCSW

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	101YM0800X	Mental Health Counselor	8620	WI

General Provider Information

NPI Number	:	1366007890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH SMETANA LCSW

Provider Business Mailing Address
First Line	:	W11560 OLD 95 RD
Second Line	:
City	:	ALMA CENTER
State	:	WI
Zip	:	54611-8539
Country	:	US
Telephone Number	:	715-896-1905
Fax Number	:

Provider Business Practice Location Address
First Line	:	W11560 OLD 95 RD
Second Line	:
City	:	ALMA CENTER
State	:	WI
Zip	:	54611-8539
Country	:	US
Telephone Number	:	715-896-1905
Fax Number	:

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

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	05/09/2019

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