Jeremy A Smith, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150113060 Issued in IL

Practice address

2101 Fox Drive Suite 102
Champaign, IL 61820-8195

Phone

(217) 766-0258

NPI assigned

Dec 17, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1174094197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 FOX DRIVE SUITE 102",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618208195",
            "telephone_number": "217-418-1094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 FOX DRIVE SUITE 102",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618208195",
            "telephone_number": "217-766-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JEREMY",
        "middle_name": "A",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-17",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150113060",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doug C Smith
• Gabrielle Smith
• Isabella Ruby Smith, COTA/L
• Jaimee Leeann Smith
• James Ralph Smith, PH.D.
• Keyera J Smith
• Leeanne Smith
• Linda Kay Smith, LCSW
• Melissa Anne Smith
• Michael A. Smith, M.D.

• Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.