Provider Demographics
NPI:1962682690
Name:SCHMIDT, RICHARD (SLP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28618 LAKECREST AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1725
Mailing Address - Country:US
Mailing Address - Phone:818-384-3863
Mailing Address - Fax:661-250-9656
Practice Address - Street 1:28618 LAKECREST AVE
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-1725
Practice Address - Country:US
Practice Address - Phone:818-384-3863
Practice Address - Fax:661-250-9656
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP003420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP003420Medicaid