MEDICARE: JULIE SCHMIDT MCDERMOTT CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5370943-4102	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5370943-4102	OTHER	UT	UTAH DEPARTMENT OF PROFESSIONAL LICENSING

General Provider Information

NPI Number	:	1255030821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE SCHMIDT MCDERMOTT CCC-SLP

Provider Business Mailing Address
First Line	:	1850 S 2500 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3242
Country	:	US
Telephone Number	:	801-712-4833
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 S 2500 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3242
Country	:	US
Telephone Number	:	801-481-4814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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Directions to “ JULIE SCHMIDT MCDERMOTT CCC-SLP” Practice Location

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