Provider Demographics
NPI:1629020821
Name:SCHMIDT, GERALD (LP)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2823
Mailing Address - Country:US
Mailing Address - Phone:507-387-2702
Mailing Address - Fax:
Practice Address - Street 1:600 REED ST
Practice Address - Street 2:SUITE 115
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6410
Practice Address - Country:US
Practice Address - Phone:507-625-4060
Practice Address - Fax:507-625-3915
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN875748800Medicaid
MNHP37003OtherHEALTH PARTNERS
MN6259774OtherUNITED
MN311T4SCOtherBX/BS
MN120013OtherUCARE OF MN