Provider Demographics
NPI:1396325551
Name:SMITH, TANNER (LMSW)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 9TH ST APT 314
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2232
Mailing Address - Country:US
Mailing Address - Phone:641-814-3936
Mailing Address - Fax:
Practice Address - Street 1:1030 5TH AVE SE STE 3000
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2416
Practice Address - Country:US
Practice Address - Phone:319-286-4545
Practice Address - Fax:319-368-3358
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker