| NPI | 1417117219 |
|---|---|
| Former Name | KELLY ELIZABETH SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 001074) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IA 001074) |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2018-07-16 |