Provider Demographics
NPI:1013218619
Name:SMITH, HEIDI LYNNE (LIMHP,)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LIMHP,
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 1:1608 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-1535
Mailing Address - Country:US
Mailing Address - Phone:402-713-9224
Mailing Address - Fax:
Practice Address - Street 1:11510 BLONDO ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3846
Practice Address - Country:US
Practice Address - Phone:402-403-0190
Practice Address - Fax:402-932-4121
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2024-08-23
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
NE100261397-00Medicaid
NE470376606-31Medicaid