Provider Demographics
NPI:1417304072
Name:SCHMIDT, DONICA A (LAC)
Entity Type:Individual
Prefix:
First Name:DONICA
Middle Name:A
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11385 SW SCHOLLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7167
Mailing Address - Country:US
Mailing Address - Phone:503-524-9040
Mailing Address - Fax:
Practice Address - Street 1:11385 SW SCHOLLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7167
Practice Address - Country:US
Practice Address - Phone:503-524-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC175766171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist