Provider Demographics
NPI:1982032306
Name:SCHMIDT, KATHERINE ROSE
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ROSE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:SCHMIDT
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:53 S 300 E
Mailing Address - Street 2:APT 20
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1638
Mailing Address - Country:US
Mailing Address - Phone:801-608-9420
Mailing Address - Fax:
Practice Address - Street 1:344 E 100 S
Practice Address - Street 2:STE 301
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1700
Practice Address - Country:US
Practice Address - Phone:801-322-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker