Provider Demographics
NPI:1588603195
Name:SCHMIDT, LAURA BETH (MS, CCC/SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BETH
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MS, CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 46
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:IL
Mailing Address - Zip Code:61452-9602
Mailing Address - Country:US
Mailing Address - Phone:309-257-2575
Mailing Address - Fax:309-257-2575
Practice Address - Street 1:RR 1 BOX 46
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:IL
Practice Address - Zip Code:61452-9602
Practice Address - Country:US
Practice Address - Phone:309-257-2575
Practice Address - Fax:309-257-2575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100044415-62762-01Medicaid