Provider Demographics
NPI:1316316250
Name:SMITH, HEATHER L (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:SMITH-SCHRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6155 OAK ST STE C
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2266
Mailing Address - Country:US
Mailing Address - Phone:816-678-0661
Mailing Address - Fax:
Practice Address - Street 1:6155 OAK ST STE C
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2266
Practice Address - Country:US
Practice Address - Phone:816-678-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018042521103TB0200X
KSLP2385103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018042521OtherMO STATE BOARD OF PSYCHOLOGISTS
KSLP2385OtherKS BOARD OF PSYCHOLOGISTS