Provider Demographics
NPI:1679711733
Name:SEMO-SCHMIDT, MICHELE M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:SEMO-SCHMIDT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:SEMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2000 BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2787
Mailing Address - Country:US
Mailing Address - Phone:262-896-3450
Mailing Address - Fax:
Practice Address - Street 1:2000 BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2787
Practice Address - Country:US
Practice Address - Phone:262-896-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1104-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41203900Medicaid