Provider Demographics
NPI:1457821183
Name:SMITH, REBECCA ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5237 ISLES RD
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-8645
Mailing Address - Country:US
Mailing Address - Phone:810-417-1503
Mailing Address - Fax:
Practice Address - Street 1:9001 MILLER RD STE 5
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1115
Practice Address - Country:US
Practice Address - Phone:989-401-2244
Practice Address - Fax:800-562-3347
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician