Provider Demographics
NPI:1912357021
Name:SCHMIDT, TRILBY DI'ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRILBY
Middle Name:DI'ANN
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 1:4514 S COVERED WAGON TRL
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-8517
Mailing Address - Country:US
Mailing Address - Phone:580-220-7461
Mailing Address - Fax:
Practice Address - Street 1:2615 E RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4670
Practice Address - Country:US
Practice Address - Phone:580-234-3734
Practice Address - Fax:580-234-2615
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100677360DMedicaid