Healthcare Provider Details

I. General information

NPI: 1215334263
Provider Name (Legal Business Name): MRS. HEATHER MARIE SMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MARIE SMIDT CSWA

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SE 1ST ST
PENDLETON OR
97801-2204
US

IV. Provider business mailing address

PO BOX 1703
PENDLETON OR
97801-0540
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-9000
  • Fax: 855-738-7698
Mailing address:
  • Phone: 541-429-9000
  • Fax: 855-738-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA3643
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: