Basic Information
| Provider Information | |||||||||
| NPI: | 1760049001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | SYDNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511051418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550204 | ||||||||
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| Practice Location | |||||||||
| Address1: | 204 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ELK POINT | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570252334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053563317 | ||||||||
| FaxNumber: | 8664236811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2019 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6181 | SD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.