Provider Demographics
NPI:1730561036
Name:SMITKE, AMY JO (LISW-S, LICDC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:SMITKE
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S, LICDC
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:OSTRANDER
Mailing Address - State:OH
Mailing Address - Zip Code:43061-0143
Mailing Address - Country:US
Mailing Address - Phone:740-974-7177
Mailing Address - Fax:
Practice Address - Street 1:185 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7619
Practice Address - Country:US
Practice Address - Phone:402-336-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.131089101YA0400X
OHI.12014251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH47-2424325OtherOHIO ADDICTION RECOVERY CENTER