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Individual
WANDA DENISE SMITH
Active
Individual
WANDA DENISE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPSYC HCPROF
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
8KUSC7H7
IL
103TC2200X
Clinical Child & Adolescent Psychologist
KWN75FB9
IL
172V00000X
Community Health Worker
8KUSC7H7
IL
261QC1500X
Community Health Clinic/Center
8KUSC7H7
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36369473001
—
IL
Enumeration date
02/12/2020
Last updated
02/12/2020
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