Provider Demographics
NPI:1487026258
Name:SCHMIDT, SKYE (MA)
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOLLIS AVE APT 61
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4835
Mailing Address - Country:US
Mailing Address - Phone:949-235-4749
Mailing Address - Fax:
Practice Address - Street 1:139 2ND ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5102
Practice Address - Country:US
Practice Address - Phone:949-235-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE 10275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist