Provider Demographics
NPI:1164049417
Name:SMITH, YVONNE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12530 SE SHELL LN
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8805
Mailing Address - Country:US
Mailing Address - Phone:503-957-4249
Mailing Address - Fax:
Practice Address - Street 1:12530 SE SHELL LN
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-8805
Practice Address - Country:US
Practice Address - Phone:503-957-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL24911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical