Provider Demographics
NPI:1396058939
Name:SMITH, VANESSA L
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N ABERDEEN ST
Mailing Address - Street 2:B605
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1615
Mailing Address - Country:US
Mailing Address - Phone:312-718-7890
Mailing Address - Fax:
Practice Address - Street 1:215 N ABERDEEN ST
Practice Address - Street 2:B605
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1615
Practice Address - Country:US
Practice Address - Phone:312-718-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst