Provider Demographics
NPI:1447615067
Name:SMITH, JODY LYN (MSW LLMSW CDP CAADC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW LLMSW CDP CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2514
Mailing Address - Country:US
Mailing Address - Phone:989-779-9449
Mailing Address - Fax:
Practice Address - Street 1:218 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2514
Practice Address - Country:US
Practice Address - Phone:989-779-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-26
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MI68011007481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other