Provider Demographics
NPI:1013218619
Name:SMITH, HEIDI LYNNE (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNNE
Other - Last Name:MADSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3300 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3402
Mailing Address - Country:US
Mailing Address - Phone:402-554-0520
Mailing Address - Fax:402-551-8797
Practice Address - Street 1:13460 WALSH DR
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7529
Practice Address - Country:US
Practice Address - Phone:402-598-3358
Practice Address - Fax:402-498-3375
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100257453-00Medicaid
NE470376606-31Medicaid
NE100261397-00Medicaid