Provider Demographics
NPI:1265502868
Name:SCHMIDT, JUDY ELLEN (MED)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ELLEN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
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Mailing Address - Street 1:11715 ADMINISTRATION DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-569-4114
Mailing Address - Fax:314-576-0560
Practice Address - Street 1:11715 ADMINISTRATION DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-569-4114
Practice Address - Fax:314-576-0560
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOCS000660101YP2500X
MOSW0025611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical