Provider Demographics
NPI:1033383930
Name:SCHMITZ, MIKALA A (SLP)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:A
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 CITY CENTRE DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3382
Mailing Address - Country:US
Mailing Address - Phone:651-738-9888
Mailing Address - Fax:651-738-9889
Practice Address - Street 1:4233 44TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-3939
Practice Address - Country:US
Practice Address - Phone:701-770-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8305235Z00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist