Provider Demographics
NPI:1881217123
Name:SMITH, LINDSEY NICOLE FAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:NICOLE FAE
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 1:1315 BUTTERFIELD RD STE 608
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 E CHURCH ST UNIT A
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2299
Practice Address - Country:US
Practice Address - Phone:815-786-8606
Practice Address - Fax:815-785-1541
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0215531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical