Provider Demographics
NPI:1942714787
Name:SMITH, LYNDSAY ANN (SSW)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 S HUMMEL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6031
Mailing Address - Country:US
Mailing Address - Phone:805-794-9396
Mailing Address - Fax:
Practice Address - Street 1:5667 S REDWOOD RD UNIT 6B
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5495
Practice Address - Country:US
Practice Address - Phone:801-979-1351
Practice Address - Fax:801-905-1161
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8311415-35031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical