Provider Demographics
NPI:1417228701
Name:SCHMIDT CLAY, KELLY MICHELE (PHD, CCC-A)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELE
Last Name:SCHMIDT CLAY
Suffix:
Gender:F
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MICHELE
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-0001
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5276
Practice Address - Country:US
Practice Address - Phone:573-882-8174
Practice Address - Fax:573-884-4205
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012005893231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360587Medicare PIN