Provider Demographics
NPI:1639535313
Name:HARDY SMITH, LEHANNA ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LEHANNA
Middle Name:ELIZABETH
Last Name:HARDY SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LEHANNA
Other - Middle Name:ELIZABETH
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:12479 STOUT AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8564
Mailing Address - Country:US
Mailing Address - Phone:517-231-8247
Mailing Address - Fax:
Practice Address - Street 1:710 KENMOOR AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2379
Practice Address - Country:US
Practice Address - Phone:616-425-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
MI68011064501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639535313Medicaid