Active NPI
Jason William Smith, PSY.D.
- Clinical Psychologist
- Spencer, IA
National Provider Identifier
1558790469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 00932
- Practice address
- 201 E 11TH St
Spencer, IA 51301-4436 - Phone
- (712) 262-2922
- NPI assigned
- Nov 1, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 00932 | IA | Primary |
Addresses
Primary practice location
201 E 11TH St
Spencer, IA 51301-4436
Mailing address
201 Lake Ave
Storm Lake, IA 50588-2432
Phone (515) 419-1742
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383264000000",
"number": "1558790469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 LAKE AVE",
"city": "STORM LAKE",
"state": "IA",
"postal_code": "505882432",
"telephone_number": "515-419-1742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 E 11TH ST",
"city": "SPENCER",
"state": "IA",
"postal_code": "513014436",
"telephone_number": "712-262-2922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JASON",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-11-01",
"last_updated": "2013-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "00932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spencer, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.