Individual
KALISSA JO SMIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
4959 UTICA RIDGE RD, DAVENPORT, IA 52807-3063
(563) 362-9631
Mailing address
4959 UTICA RIDGE RD, DAVENPORT, IA 52807-3063
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-26-2829318
IA
Other
Enumeration date
07/13/2026
Last updated
07/13/2026
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