Smith, Diana
Smith, Diana is an individual health care provider with primary practice located at 2815 Pershing Blvd , Granite City IL 62040-5952. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as her primary health care specialty. Smith, Diana can be contacted via phone (618) 600-4441.Contact Information
Primary practice address
2815 Pershing Blvd
Granite City IL 62040-5952
Phone: (618) 600-4441
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavior Technician | 106S00000X |
Profile Details
| NPI number | 1245936749 |
|---|---|
| LBN Legal business name | Smith, Diana |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 6th, 2023 |
| Last updated | Feb 6th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245936749 | NPPES |
| Illinois | MEDICAID | 132656323 |
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