MEDICARE: JUDI LYNN SMITH LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1881378479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDI LYNN SMITH LADC

Provider Business Mailing Address
First Line	:	PO BOX 1208
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69103-1208
Country	:	US
Telephone Number	:	308-534-6029
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 W 3RD ST
Second Line	:
City	:	MC COOK
State	:	NE
Zip	:	69001-2527
Country	:	US
Telephone Number	:	308-345-2770
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ JUDI LYNN SMITH LADC” Practice Location

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