Healthcare Provider Details

I. General information

NPI: 1972374205
Provider Name (Legal Business Name): SAVANNAH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 61ST ST N
PARK CITY KS
67219-1903
US

IV. Provider business mailing address

425 E 61ST ST N
PARK CITY KS
67219-1903
US

V. Phone/Fax

Practice location:
  • Phone: 913-662-7071
  • Fax:
Mailing address:
  • Phone: 913-662-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: