Provider Demographics
NPI:1649399718
Name:SCHMIDT-POWELL, MARISSA M (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:M
Last Name:SCHMIDT-POWELL
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:PO BOX 5763
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0763
Mailing Address - Country:US
Mailing Address - Phone:503-508-1600
Mailing Address - Fax:503-304-0856
Practice Address - Street 1:2262 BANYONWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1341
Practice Address - Country:US
Practice Address - Phone:503-508-1600
Practice Address - Fax:503-304-0856
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR205471Medicaid
OR11603OtherOREGON LICENSE NUMBER