Provider Demographics
NPI:1740806140
Name:SMITH, TIERRA MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TIERRA
Other - Middle Name:MARIE
Other - Last Name:LUPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 TRITON CIR
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5798
Mailing Address - Country:US
Mailing Address - Phone:515-576-7201
Mailing Address - Fax:
Practice Address - Street 1:1 TRITON CIR
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5798
Practice Address - Country:US
Practice Address - Phone:515-576-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker