Individual
SAMUEL C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
509 MCMILLEN ST, FORT ATKINSON, WI 53538-1263
(920) 563-7995
(920) 568-6047
Mailing address
509 MCMILLEN ST, FORT ATKINSON, WI 53538-1263
(920) 563-7995
(920) 568-6047
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
528-056
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39041100
—
WI
Enumeration date
07/26/2006
Last updated
07/08/2007
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