Provider Demographics
NPI:1245926104
Name:SMITH, KRISTIN JENNIFER (MSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JENNIFER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SW PUFF LN APT 13
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1574
Mailing Address - Country:US
Mailing Address - Phone:503-308-1413
Mailing Address - Fax:
Practice Address - Street 1:1040 SW PUFF LN APT 13
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1574
Practice Address - Country:US
Practice Address - Phone:503-308-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health