Provider Demographics
NPI:1154100014
Name:SMITH, SKYLER RAE (MSW)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SKYLER
Other - Middle Name:RAE
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:45151 NORTHPORT DR APT 2209
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5334
Mailing Address - Country:US
Mailing Address - Phone:586-817-1571
Mailing Address - Fax:
Practice Address - Street 1:45151 NORTHPORT DR APT 2209
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5334
Practice Address - Country:US
Practice Address - Phone:586-817-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511167871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty