Active NPI
Kelly Jean Smith, PH.D., LPC
- Professional Counselor
- Racine, WI
National Provider Identifier
1013539477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 7421-125
- Practice address
- 1717 Taylor Ave
Racine, WI 53403-2405 - Phone
- (262) 638-6771
- NPI assigned
- May 8, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 7421-125 | WI | Primary |
Addresses
Primary practice location
1717 Taylor Ave
Racine, WI 53403-2405
Mailing address
1717 Taylor Ave
Racine, WI 53403-2405
Phone (262) 638-6771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7421-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588896000000",
"number": "1013539477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 TAYLOR AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534032405",
"telephone_number": "262-638-6771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 TAYLOR AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534032405",
"telephone_number": "262-638-6771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KELLY",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "PH.D., LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-08",
"last_updated": "2020-05-08",
"certification_date": "2020-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "7421-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.