Healthcare Provider Details

I. General information

NPI: 1285409615
Provider Name (Legal Business Name): MRS. ABIGAIL ROSE SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SERENITY LN
COBURG OR
97408-9350
US

IV. Provider business mailing address

91150 N INDUSTRIAL WAY
COBURG OR
97408-9512
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-1110
  • Fax: 541-228-3604
Mailing address:
  • Phone: 541-687-1110
  • Fax: 541-228-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-22-1789
License Number StateOR

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: