Provider Demographics
NPI:1629243274
Name:SCHAETZ, DOREEN ANN (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:ANN
Last Name:SCHAETZ
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 PIONEER FORK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1675
Mailing Address - Country:US
Mailing Address - Phone:801-583-6103
Mailing Address - Fax:801-583-6103
Practice Address - Street 1:5435 PIONEER FORK RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1675
Practice Address - Country:US
Practice Address - Phone:801-583-6103
Practice Address - Fax:801-583-6103
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT293783-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist