Individual
JESSICA LYNN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
44 GOOD COUNSEL DR, MANKATO, MN 56001-6599
(800) 438-1772
(262) 345-5562
Mailing address
W175N11120 STONEWOOD DR, GERMANTOWN, WI 53022-6511
(800) 438-1772
(262) 345-5531
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2659
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275831786
—
MN
01
—
39-1047224
TAX ID
WI
Enumeration date
03/08/2011
Last updated
10/08/2019
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