Individual
DIANA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2815 PERSHING BLVD, GRANITE CITY, IL 62040-5952
(618) 600-4441
Mailing address
2815 PERSHING BLVD, GRANITE CITY, IL 62040-5952
(618) 600-4441
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132656323
—
IL
Enumeration date
02/06/2023
Last updated
02/06/2023
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