Provider Demographics
NPI:1700813623
Name:SMOTHERS, ANDREA KRISTIN (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KRISTIN
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992
Mailing Address - Country:US
Mailing Address - Phone:507-732-4136
Mailing Address - Fax:507-732-4411
Practice Address - Street 1:77 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992
Practice Address - Country:US
Practice Address - Phone:507-732-4136
Practice Address - Fax:507-732-4411
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1034004OtherPREF ONE
125740OtherMMSI
127608OtherU CARE
694S5SMOtherBCBS
6231853OtherMEDICA
990991034004OtherPEAK