Individual
BRANDIS DIANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
440 W BOUGHTON RD STE 104, BOLINGBROOK, IL 60440-1400
(331) 318-1818
Mailing address
15 S EASTERN AVE UNIT 3, JOLIET, IL 60433-1038
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.101376
IL
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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