Smith, Jacquelyn J

Smith, Jacquelyn J is an individual health care provider with primary practice located at 9000 W Wisconsin Ave B510, Milwaukee WI 53226-4874. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Smith, Jacquelyn J can be contacted via phone (414) 266-2932.

Contact Information

Primary practice address
9000 W Wisconsin Ave B510 Milwaukee WI 53226-4874
Phone: (414) 266-2932
Fax: (414) 266-3735
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 3053-57 Wisconsin

Profile Details

NPI number 1346509510
LBN Legal business name Smith, Jacquelyn J
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date May 9th, 2012
Last updated Jan 4th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346509510 NPPES
Wisconsin MEDICAID 1346509510

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