Provider Demographics
NPI:1598797185
Name:SCHMIDT, MARY K (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2625
Mailing Address - Country:US
Mailing Address - Phone:218-736-6987
Mailing Address - Fax:
Practice Address - Street 1:126 E ALCOTT AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2903
Practice Address - Country:US
Practice Address - Phone:218-736-6987
Practice Address - Fax:218-736-6980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1010531OtherPREFERREDONE
MN116407OtherUCARE MINNESOTA
MNHP23071OtherHEALTHPARTNERS
MN61-20354OtherUNITED BEHAVIORAL HEALTH
MN914750100Medicaid
FM61813SCOtherBLUE SHIELD OF MINNESOTA
MNHP23071OtherHEALTHPARTNERS