Individual
TIFFANY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
1407 SAINT ANDREW ST, SUITE 100, LA CROSSE, WI 54603-3301
(608) 785-6266
Mailing address
12552 US HIGHWAY 61, FENNIMORE, WI 53809-9613
(608) 732-3710
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
10891-120
WI
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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