Provider Demographics
NPI:1164542247
Name:SCHMIT, ELIZABETH SLABACH (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SLABACH
Last Name:SCHMIT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13510
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-0510
Mailing Address - Country:US
Mailing Address - Phone:503-353-8599
Mailing Address - Fax:503-353-8549
Practice Address - Street 1:6400 SE LAKE RD
Practice Address - Street 2:SUITE 285
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2129
Practice Address - Country:US
Practice Address - Phone:503-353-8599
Practice Address - Fax:503-353-8549
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
109318Medicare ID - Type Unspecified