Provider Demographics
NPI:1518269331
Name:SMITH, JEREMY O (LBSW)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:O
Last Name:SMITH
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E. ROSSER AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4058
Mailing Address - Country:US
Mailing Address - Phone:701-222-6670
Mailing Address - Fax:701-328-8900
Practice Address - Street 1:415 E. ROSSER AVE
Practice Address - Street 2:STE 113
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4058
Practice Address - Country:US
Practice Address - Phone:701-222-6670
Practice Address - Fax:701-328-8900
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ND4478171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator