MEDICARE: MS. JENNIFER ANN SMITH M.ED., PCC

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	101YP2500X	Professional Counselor	E 0501056	OH

General Provider Information

NPI Number	:	1417021999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANN SMITH M.ED., PCC

Provider Business Mailing Address
First Line	:	5592 CRAWFORD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-4176
Country	:	US
Telephone Number	:	614-846-6597
Fax Number	:

Provider Business Practice Location Address
First Line	:	453 ALLENBY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-8722
Country	:	US
Telephone Number	:	937-642-0048
Fax Number	:	937-642-1316

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/26/2010

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