Healthcare Provider Details

I. General information

NPI: 1588719108
Provider Name (Legal Business Name): SANDEE SCHUMACHER MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/26/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 N EISENHOWER ST
MOSCOW ID
83843-9588
US

IV. Provider business mailing address

1027 REAMS RD
MOSCOW ID
83843-7836
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-6560
  • Fax:
Mailing address:
  • Phone: 231-342-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00004322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: