Provider Demographics
NPI:1104496595
Name:SMITH, JODY KATRINA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:KATRINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:KATRINA
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1359 WESTBROOKE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4055
Mailing Address - Country:US
Mailing Address - Phone:530-651-4184
Mailing Address - Fax:
Practice Address - Street 1:2700 HARVARD RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2621
Practice Address - Country:US
Practice Address - Phone:785-832-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12139104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker