Provider Demographics
NPI:1871540419
Name:SMUCKER, NANCY JO (LISW LPCC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JO
Last Name:SMUCKER
Suffix:
Gender:F
Credentials:LISW LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 WESTERN OHIO AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-228-4555
Mailing Address - Fax:419-228-2717
Practice Address - Street 1:2371 WESTERN OHIO AVENUE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-228-4555
Practice Address - Fax:419-228-2717
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00018751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000289839OtherBLUE CROSS BLUE SHIELD
OH0000289839OtherBLUE CROSS BLUE SHIELD