Provider Demographics
NPI:1619966595
Name:SMITH, ELIZABETH ROSE (MS, LCGC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:1117 29TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5306
Mailing Address - Country:US
Mailing Address - Phone:406-731-8200
Mailing Address - Fax:406-731-8100
Practice Address - Street 1:1117 29TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5306
Practice Address - Country:US
Practice Address - Phone:406-731-8200
Practice Address - Fax:406-731-8100
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTGEN-GEN-LIC-000016170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS