Healthcare Provider Details

I. General information

NPI: 1972558153
Provider Name (Legal Business Name): GLORIA M SCHNELL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR SUITE 236
COEUR D ALENE ID
83814-4484
US

IV. Provider business mailing address

700 W IRONWOOD DR SUITE 236
COEUR D ALENE ID
83814-4484
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-1345
  • Fax: 208-667-9622
Mailing address:
  • Phone: 208-765-1345
  • Fax: 208-667-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number20618
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1171
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD1832
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0309167354
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number382
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAUD1832
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: