Individual
CHANNEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1809 VISSCHER DR, ELKHART, IN 46514-6505
(773) 491-5423
Mailing address
1809 VISSCHER DR, ELKHART, IN 46514-6505
(773) 491-5423
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83-4511368
—
IN
Enumeration date
03/27/2020
Last updated
03/27/2020
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