Healthcare Provider Details

I. General information

NPI: 1588450845
Provider Name (Legal Business Name): DEANNA LYNN SMITH LCSW, LSCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE 32ND ST
KANSAS CITY MO
64116-2983
US

IV. Provider business mailing address

5712 NW 96TH ST
KANSAS CITY MO
64154-7841
US

V. Phone/Fax

Practice location:
  • Phone: 816-412-2900
  • Fax:
Mailing address:
  • Phone: 816-591-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004855
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: