Provider Demographics
NPI:1720868763
Name:THOMAS SMITH, EMMY LOU (BSW)
Entity Type:Individual
Prefix:MRS
First Name:EMMY LOU
Middle Name:
Last Name:THOMAS SMITH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3404
Mailing Address - Country:US
Mailing Address - Phone:949-374-1229
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3404
Practice Address - Country:US
Practice Address - Phone:949-374-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program