Individual
JESSICA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1319 W MAY, WICHITA, KS 67212
(316) 262-0505
Mailing address
1804 DENVER, PARK CITY, KS 67219
(316) 304-2400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
404
KS
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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