Healthcare Provider Details

I. General information

NPI: 1003738600
Provider Name (Legal Business Name): BENJAMIN DEAN SCHMIDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10112 W OVERLAND RD
BOISE ID
83709-1428
US

IV. Provider business mailing address

902 S FERN ST APT 102
NAMPA ID
83686-6885
US

V. Phone/Fax

Practice location:
  • Phone: 208-495-5401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14234425-4102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6881216
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: