Provider Demographics
NPI:1851831473
Name:S M I L E INC
Entity type:Organization
Organization Name:S M I L E INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VEASEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MSW, APSW, SAC-IT
Authorized Official - Phone:262-343-5609
Mailing Address - Street 1:4222 W CAPITOL DR STE 308
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2500
Mailing Address - Country:US
Mailing Address - Phone:262-343-5609
Mailing Address - Fax:414-249-3312
Practice Address - Street 1:4222 W CAPITOL DR STE 308
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2500
Practice Address - Country:US
Practice Address - Phone:262-343-5609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100077100Medicaid