Provider Demographics
NPI:1194316737
Name:SMITH, HANNAH LORAE (BS)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LORAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4701
Mailing Address - Country:US
Mailing Address - Phone:208-791-9743
Mailing Address - Fax:
Practice Address - Street 1:807 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4701
Practice Address - Country:US
Practice Address - Phone:208-791-9743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician