Provider Demographics
NPI:1215334263
Name:SMIDT, HEATHER MARIE
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:SMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:SMIDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSWA
Mailing Address - Street 1:PO BOX 1703
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0540
Mailing Address - Country:US
Mailing Address - Phone:541-429-9000
Mailing Address - Fax:855-738-7698
Practice Address - Street 1:114 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2204
Practice Address - Country:US
Practice Address - Phone:541-429-9000
Practice Address - Fax:855-738-7698
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA36431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical