Individual
CASEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SST
Contact information
Practice address
401 10TH AVE, MENOMINEE, MI 49858-3009
(906) 863-7841
Mailing address
715 PYLE DR, KINGSFORD, MI 49802-4456
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6803086870
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6803086870
SST LICENSE
MI
Enumeration date
03/31/2022
Last updated
03/31/2022
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