Doctor Name: | DEANNA SUE SMITH |
NPI Number: | 1093177719 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LMSW-31238 |
Business Practice Address: | 265 E Chubbuck Rd Ste A Chubbuck, ID - 832025055 |
Business Phone Number: | 2082371711 |
Business Fax Number: | |
Mailing Address: | 2497 N Furgeson Ln, INKOM |
State: | ID |
Postal Code: | 832451617 |
Phone Number: | 2082417681 |
Fax Number: | 2082367423 |
NPI Enumeration Date: | 03/22/2016 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LMSW-31238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |