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Individual

BROOKELYNN MAE FREED SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW, MSW, BSW

Contact information

Practice address
712 S MAIN ST, JOPLIN, MO 64801-4502
(417) 621-0373
Mailing address
712 S MAIN ST, JOPLIN, MO 64801-4502
(417) 621-0373

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
2020022699
MO
1041C0700X
Clinical Social Worker
2020022699
MO
1041C0700X
Clinical Social Worker
Primary
2022038812
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2020022699
MASTER OF SOCIAL WORK LICENSE
MO
01
2022038812
CLINICAL SOCIAL WORK LICENSE
MO
Enumeration date
08/24/2020
Last updated
09/30/2022
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