Provider Demographics
NPI:1295957298
Name:SCHULZ, DEVAN KENNETH (ASD)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:KENNETH
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:ASD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 SW RHYOLITE PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1673
Mailing Address - Country:US
Mailing Address - Phone:541-350-6909
Mailing Address - Fax:
Practice Address - Street 1:1379 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2905
Practice Address - Country:US
Practice Address - Phone:541-548-6166
Practice Address - Fax:541-548-6168
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health