Individual
MRS. AUDREY ELAINE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
325 IL ROUTE 2, DIXON, IL 61021-9118
(815) 288-6611
Mailing address
325 IL ROUTE 2, DIXON, IL 61021-9118
(815) 288-6611
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/10/2019
Last updated
05/16/2025
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