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NPI Code Detail

MEDICARE: KALLIE JO SMITH CSW

MEDICARE:   KALLIE JO SMITH  CSW
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 Worker259186KY

General Provider Information

NPI Number : 1780424358
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALLIE JO SMITH CSW
Provider Business Mailing Address
First Line : 448 LEWIS HARGETT CIR STE 260
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-3506
Country : US
Telephone Number : 859-338-0466
Fax Number :
Provider Business Practice Location Address
First Line : 448 LEWIS HARGETT CIR STE 260
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-3506
Country : US
Telephone Number : 859-338-0466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2024
Last Update Date : 05/30/2024

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