Healthcare Provider Details

I. General information

NPI: 1437718905
Provider Name (Legal Business Name): STEPHANIE SCHMIEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 KIRKWOOD BLVD SW
CEDAR RAPIDS IA
52404-5298
US

IV. Provider business mailing address

20778 215TH ST
MONTICELLO IA
52310-7532
US

V. Phone/Fax

Practice location:
  • Phone: 319-784-2105
  • Fax:
Mailing address:
  • Phone: 319-319-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086539
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: