Provider Demographics
NPI:1598913162
Name:DEUEL SCHRAM, CHARISSE NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:NICOLE
Last Name:DEUEL SCHRAM
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 1:18715 ALDER DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-6414
Mailing Address - Country:US
Mailing Address - Phone:402-850-6795
Mailing Address - Fax:
Practice Address - Street 1:18715 ALDER DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-6414
Practice Address - Country:US
Practice Address - Phone:402-850-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2648235Z00000X
IA1891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist