MEDICARE: SMITH, STOCKHAMMER AND ASSOCIATES, PLLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1396982211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH, STOCKHAMMER AND ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	6511 GLENRIDGE PARK PL
Second Line	:	STE 5
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-3452
Country	:	US
Telephone Number	:	502-614-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6511 GLENRIDGE PARK PL
Second Line	:	STE 5
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-3452
Country	:	US
Telephone Number	:	502-614-7600
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. FELICIA D. SMITH
Credential	:	PHD
Telephone Number	:	502-614-7600

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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