Healthcare Provider Details

I. General information

NPI: 1275343196
Provider Name (Legal Business Name): JOANNA LEE MARIE SMITH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 MONROVIA ST STE 310
LENEXA KS
66215-3500
US

IV. Provider business mailing address

8700 MONROVIA ST STE 310
LENEXA KS
66215-3500
US

V. Phone/Fax

Practice location:
  • Phone: 913-372-1787
  • Fax: 317-936-1241
Mailing address:
  • Phone: 913-372-1787
  • Fax: 317-936-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberK00206919
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: