Smith, Wanda Denise

Smith, Wanda Denise is an sole proprietor health care provider with primary practice located at 17100 Dixie Hwy Ste D , Hazel Crest IL 60429-1485. She recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Other Service Providers / Community Health Worker, Ambulatory Health Care Facilities / Community Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Smith, Wanda Denise can be contacted via phone (331) 643-5238.

Contact Information

Primary practice address
17100 Dixie Hwy Ste D Hazel Crest IL 60429-1485
Phone: (331) 643-5238
Fax: (708) 991-7320
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X KWN75FB9 Illinois
Other Service Providers / Community Health Worker 172V00000X 8KUSC7H7 Illinois
Ambulatory Health Care Facilities / Community Health 261QC1500X 8KUSC7H7 Illinois
Behavioral Health & Social Service Providers / Clinical 103TC0700X 8KUSC7H7 Illinois

Profile Details

NPI number 1114550688
LBN Legal business name Smith, Wanda Denise
Credentials CPSYC HCPROF
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 12th, 2020
Last updated Feb 12th, 2020 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114550688 NPPES
Illinois MEDICAID 36369473001

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