Provider Demographics
NPI:1487878294
Name:SCHMIDT, LONNA (MST-CCC)
Entity type:Individual
Prefix:
First Name:LONNA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MST-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401
Mailing Address - Country:US
Mailing Address - Phone:701-952-5142
Mailing Address - Fax:701-952-1450
Practice Address - Street 1:701 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-952-5142
Practice Address - Fax:701-952-1450
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1459072Medicaid