Provider Demographics
NPI:1861676017
Name:SMITH, AUDREY ROWELL
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ROWELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:VERA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5326 SOLDIERS HOME MSBG RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-1459
Mailing Address - Country:US
Mailing Address - Phone:937-859-6398
Mailing Address - Fax:928-244-2547
Practice Address - Street 1:5326 SOLDIERS HOME MSBG RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-1459
Practice Address - Country:US
Practice Address - Phone:937-859-6398
Practice Address - Fax:928-244-2547
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical