Provider Demographics
NPI:1023640034
Name:SCHLICHT, FAITH KELLY DAMMANN (PA-C)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:KELLY DAMMANN
Last Name:SCHLICHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:KELLY
Other - Last Name:DAMMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2911
Mailing Address - Country:US
Mailing Address - Phone:320-282-9315
Mailing Address - Fax:
Practice Address - Street 1:1406 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-255-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MN13331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant