MEDICARE: SUSAN G SCHMITZ LISW, RPT-S

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	1041C0700X	Clinical Social Worker	02299	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437159928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN G SCHMITZ LISW, RPT-S

Provider Business Mailing Address
First Line	:	1150 5TH ST STE 261
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2914
Country	:	US
Telephone Number	:	319-354-0786
Fax Number	:	319-358-6310

Provider Business Practice Location Address
First Line	:	1150 5TH ST STE 261
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2914
Country	:	US
Telephone Number	:	319-354-0786
Fax Number	:	319-358-6310

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	05/28/2010

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Directions to “ SUSAN G SCHMITZ LISW, RPT-S” Practice Location

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