Joella Jacquelyn Smith, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

01360 Issued in IA

Practice address

4403 1St Ave SE
Ste 309
Cedar Rapids, IA 52402-3200

Phone

(319) 362-0632

Fax

(319) 362-5206

NPI assigned

Jan 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Ms. Jodi Jacquelyn Smith Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Abbe Center for Community Mental Health, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cedar Rapids, IA
  • NPI 1366299018
  NPD (past)
• Community Mental Health Center for Mid-Eastern Iowa

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Iowa City, IA
  • NPI 1124097134
  NPD (past)

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361145600000",
    "number": "1306824388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 1ST AVE SE",
            "address_2": "STE 309",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524023200",
            "telephone_number": "319-362-0632",
            "fax_number": "319-362-5206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 1ST AVE SE",
            "address_2": "STE 309",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524023200",
            "telephone_number": "319-362-0632",
            "fax_number": "319-362-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOELLA",
        "middle_name": "JACQUELYN",
        "name_prefix": "Ms.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-09",
        "last_updated": "2013-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "01360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "13498",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "164104",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "20032571405",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "6273362",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0474999",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "2223660",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "175396",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JODI",
            "last_name": "SMITH",
            "middle_name": "JACQUELYN",
            "prefix": "MS.",
            "credential": "LISW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jaclyn Rae Smith, DNP-BC
• Jamie Lynn Smith, ARNP
• Jennifer Mae Smith, PHARM.D.
• Jessica Smith, PTA
• Jodie Smith
• Karla Dawn Smith, LMT
• Linae Maria Smith, CCC-A
• Madeline Smith, LMSW
• Sidney J Smith, M.D.
• Stephanie Renee Smith, CADC

• Clinical Social Worker in Cedar Rapids, IA
• Providers in Cedar Rapids, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; 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.