Provider Demographics
NPI:1033787825
Name:SCHWARTZ, EMILY ANNA (MA, RDT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNA
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MA, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 LAUREL AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6923
Mailing Address - Country:US
Mailing Address - Phone:407-619-7233
Mailing Address - Fax:
Practice Address - Street 1:1106 LAUREL AVE APT 5
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6923
Practice Address - Country:US
Practice Address - Phone:407-619-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
802