Provider Demographics
NPI:1083768212
Name:SCHUETZLE, MARTI JO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTI
Middle Name:JO
Last Name:SCHUETZLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:MARTI
Other - Middle Name:JO
Other - Last Name:VOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2909 PLAINVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554
Mailing Address - Country:US
Mailing Address - Phone:701-226-7933
Mailing Address - Fax:
Practice Address - Street 1:2007 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-5001
Practice Address - Country:US
Practice Address - Phone:701-663-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54610Medicaid