Individual provider Active NPI

Leeann Mashauna Smith, CRM

  • Prevention Professional
  • Pendleton, OR
National Provider Identifier
1508459579
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prevention ProfessionalTaxonomy code 405300000X
License
21-CRM-373 Issued in OR
Practice address
46314 Timine Way
Pendleton, OR 97801-9417
Phone
(541) 966-9830
Fax
(541) 240-8754
NPI assigned
Feb 19, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prevention Professional 405300000X 21-CRM-373 OR Primary

Addresses

Primary practice location

46314 Timine Way
Pendleton, OR 97801-9417

Mailing address

46314 Timine Way
Pendleton, OR 97801-9417
Phone (541) 966-9830

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL LindaHettinga@yellowhawk.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
21-CRM-373ORMDPrevention Professional

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1508459579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019417",
            "telephone_number": "541-966-9830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019417",
            "telephone_number": "541-966-9830",
            "fax_number": "541-240-8754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LEEANN",
        "middle_name": "MASHAUNA",
        "credential": "CRM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "OR",
            "license": "21-CRM-373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "LindaHettinga@yellowhawk.org",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "address_1": "46314 Timine Way",
            "city": "Pendleton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "978019417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pendleton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.