Provider Demographics
NPI:1134657919
Name:SMILLIE, PETER WILLIAM (CADC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:WILLIAM
Last Name:SMILLIE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HIGHWAY 61 N
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1243
Mailing Address - Country:US
Mailing Address - Phone:319-523-8436
Mailing Address - Fax:
Practice Address - Street 1:304 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1243
Practice Address - Country:US
Practice Address - Phone:319-523-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16088101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)