Provider Demographics
NPI:1538848734
Name:SMITH, KELTON (BSW)
Entity type:Individual
Prefix:
First Name:KELTON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHESAPEAKE PLZ
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-1003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11661 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:GLENFORD
Practice Address - State:OH
Practice Address - Zip Code:43739-9620
Practice Address - Country:US
Practice Address - Phone:740-616-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator