Provider Demographics
NPI:1831669282
Name:SCHMIDT, DEANDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEANDRA
Middle Name:
Last Name:SCHMIDT
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 1:21243 VENTURA BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2111
Mailing Address - Country:US
Mailing Address - Phone:818-448-6211
Mailing Address - Fax:
Practice Address - Street 1:21243 VENTURA BLVD STE 225
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2111
Practice Address - Country:US
Practice Address - Phone:818-448-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist