Provider Demographics
NPI:1982016093
Name:SCHMIDT, LACEY N (PSYD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:N
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PSYD
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 153
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-0153
Mailing Address - Country:US
Mailing Address - Phone:608-440-9004
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PL STE 260
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4043
Practice Address - Country:US
Practice Address - Phone:608-440-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3129-57103TC0700X
WI3129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical