Provider Demographics
NPI:1255893988
Name:SCHMIDT, ARIEL
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3658 WILTSEY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9303
Mailing Address - Country:US
Mailing Address - Phone:503-580-7725
Mailing Address - Fax:503-362-2572
Practice Address - Street 1:3658 WILTSEY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-9303
Practice Address - Country:US
Practice Address - Phone:503-580-7725
Practice Address - Fax:503-362-2572
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities