Provider Demographics
NPI:1255518882
Name:SMIT, JENNIFER (MSE)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SMIT
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3103
Mailing Address - Country:US
Mailing Address - Phone:920-886-6635
Mailing Address - Fax:
Practice Address - Street 1:731 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3103
Practice Address - Country:US
Practice Address - Phone:920-886-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIS530000599214171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator