Provider Demographics
NPI:1013762608
Name:SCHLAEFER, MARY J
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:SCHLAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 NW SISEMORE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2884
Mailing Address - Country:US
Mailing Address - Phone:541-647-8754
Mailing Address - Fax:
Practice Address - Street 1:20805 COOLEY RD # 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8076
Practice Address - Country:US
Practice Address - Phone:541-647-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR013078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist