MEDICARE: CRYSTAL JEWELL SMITH LMSW

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	104100000X	Social Worker	7795	KS

General Provider Information

NPI Number	:	1831490028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL JEWELL SMITH LMSW

Provider Business Mailing Address
First Line	:	131 N SANTA FE AVE STE 1A
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-2642
Country	:	US
Telephone Number	:	785-823-1245
Fax Number	:	785-823-1940

Provider Business Practice Location Address
First Line	:	131 N SANTA FE AVE STE 1A
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-2642
Country	:	US
Telephone Number	:	785-823-1245
Fax Number	:	785-823-1940

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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