Provider Demographics
NPI:1619487519
Name:SCHULTZ, BERNADETTE H (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:H
Last Name:SCHULTZ
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:PO BOX 2536
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-2536
Mailing Address - Country:US
Mailing Address - Phone:701-258-1569
Mailing Address - Fax:701-223-1669
Practice Address - Street 1:4530 NORTHERN SKY DR
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58503-5850
Practice Address - Country:US
Practice Address - Phone:701-751-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1608OtherND STATE LICENSE