Shannon Mary Jaakola Smith, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2741 Issued in MN

Practice address

26246 Crane Rd
White Earth, MN 56591-9998

Phone

(612) 296-7295

Fax

(612) 872-2955

NPI assigned

Jan 5, 2018

Last updated

Mar 19, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1487161972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26246 CRANE RD",
            "city": "WHITE EARTH",
            "state": "MN",
            "postal_code": "565919998",
            "telephone_number": "612-296-7295",
            "fax_number": "612-872-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26246 CRANE RD",
            "city": "WHITE EARTH",
            "state": "MN",
            "postal_code": "565919998",
            "telephone_number": "612-296-7295",
            "fax_number": "612-872-2955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 W Franklin Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554042331",
            "country_code": "US",
            "telephone_number": "612-813-1589 x6633",
            "fax_number": "612-872-2955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANNON",
        "middle_name": "MARY JAAKOLA",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-05",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Fredericka Samura
• James M. Schmitt, LSW
• Vanessa Rae Simon, MS, NCC, LPCC
• Judy Simpson, LICSW
• Sean Simpson, LGSW
• White Earth Band of Chippewa
• White Earth Band of Chippewa (White Earth Mental Health Program)
• White Earth Band of Chippewa (White Earth Dialysis)
• White Earth Band of Chippewa (White Earth Chemical Dependency Program)
• White Earth Band of Chippewa

• Marriage & Family Therapist in White Earth, MN
• Providers in White Earth, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.