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NPI Code Detail

MEDICARE: MS. ANN BLAISDELL SMITH LCSW

MEDICARE: MS. ANN BLAISDELL SMITH 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
11041C0700XClinical Social Worker34003458AIN

General Provider Information

NPI Number : 1417088519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANN BLAISDELL SMITH LCSW
Provider Business Mailing Address
First Line : 1531 13TH ST STE 2540
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-1305
Country : US
Telephone Number : 812-372-3745
Fax Number : 812-372-5367
Provider Business Practice Location Address
First Line : 1531 13TH ST STE 2540
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-1305
Country : US
Telephone Number : 812-372-3745
Fax Number : 812-372-5367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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