Individual
JESSICA T SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMH DD PROVIDER
Contact information
Practice address
1100 KENNESAW RIDGE RD, UNIT 807, COLUMBIA, MO 65202-4864
(573) 990-9999
Mailing address
303 MACAW DR, COLUMBIA, MO 65202-6284
(773) 332-6106
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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