Provider Demographics
NPI:1669925046
Name:DEANDRA SCHMIDT, M.S., CCC-SLP
Entity type:Organization
Organization Name:DEANDRA SCHMIDT, M.S., CCC-SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANDRA
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:818-448-6211
Mailing Address - Street 1:21243 VENTURA BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2111
Mailing Address - Country:US
Mailing Address - Phone:818-448-6211
Mailing Address - Fax:
Practice Address - Street 1:21243 VENTURA BLVD STE 225
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2111
Practice Address - Country:US
Practice Address - Phone:818-448-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty