=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437488723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE M SCHAD SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2009
-----------------------------------------------------
Last Update Date | 09/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 N COURT STREET
-----------------------------------------------------
City | BUENA VISTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-238-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 512 E 9TH ST UNIT 2
-----------------------------------------------------
City | LEADVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80461-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-983-3999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 17134637
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------