Provider Demographics
NPI:1285851790
Name:SMITH, AMANDA M (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10839 HASKINS ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3709
Mailing Address - Country:US
Mailing Address - Phone:913-481-2727
Mailing Address - Fax:
Practice Address - Street 1:500 LIMIT ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4435
Practice Address - Country:US
Practice Address - Phone:913-682-5118
Practice Address - Fax:913-682-4664
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker