Provider Demographics
NPI:1093177719
Name:SMITH, DEANNA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E CENTER
Mailing Address - Street 2:STE 40
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6372
Mailing Address - Country:US
Mailing Address - Phone:208-545-7966
Mailing Address - Fax:208-241-6215
Practice Address - Street 1:214 E CENTER
Practice Address - Street 2:STE 40
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6372
Practice Address - Country:US
Practice Address - Phone:208-545-7966
Practice Address - Fax:208-241-6215
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-312381041C0700X
IDLCSW-394221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical