Provider Demographics
NPI:1114816352
Name:SCHMIDT, JUDY ANN (MFT STUDENT INTERN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MFT STUDENT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 SE BRAE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4783
Mailing Address - Country:US
Mailing Address - Phone:503-778-0787
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER RD STE 201
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2301
Practice Address - Country:US
Practice Address - Phone:503-778-0787
Practice Address - Fax:503-296-2938
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1928390200000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health