Active NPI
Stephanie Rae Smith, CLC
- Counselor
- West Bend, WI
National Provider Identifier
1487160644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- ALPP-42079
- Practice address
- 5126 Martha Dr
West Bend, WI 53095-8794 - Phone
- (262) 501-1359
- NPI assigned
- Dec 22, 2017
- Last updated
- Jun 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | ALPP-42079 | WI | Primary |
Addresses
Primary practice location
5126 Martha Dr
West Bend, WI 53095-8794
Mailing address
5126 Martha Dr
West Bend, WI 53095-8794
Phone (262) 501-1359
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ALPP-42079 | WI | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1487160644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5126 MARTHA DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530958794",
"telephone_number": "262-501-1359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5126 MARTHA DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530958794",
"telephone_number": "262-501-1359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "STEPHANIE",
"middle_name": "RAE",
"credential": "CLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-22",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WI",
"license": "ALPP-42079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.