Provider Demographics
NPI:1477621670
Name:SCHMIDT, JADE MARIE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:MARIE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4194
Mailing Address - Country:US
Mailing Address - Phone:407-739-3252
Mailing Address - Fax:
Practice Address - Street 1:3590 N US HIGHWAY 17/92
Practice Address - Street 2:SUITE 1038
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4510
Practice Address - Country:US
Practice Address - Phone:407-322-6222
Practice Address - Fax:407-322-5596
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888401300Medicaid