Provider Demographics
NPI:1053787226
Name:SMITH, VALERIE ANN
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 BRUNO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-1226
Mailing Address - Country:US
Mailing Address - Phone:314-718-7836
Mailing Address - Fax:
Practice Address - Street 1:3165 MCKELVEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2550
Practice Address - Country:US
Practice Address - Phone:314-206-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator