MEDICARE: MR. BENJAMIN PAUL SCHADE LSP

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	103TS0200X	School Psychologist	SP.00761	OH

General Provider Information

NPI Number	:	1447190863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN PAUL SCHADE LSP

Provider Business Mailing Address
First Line	:	2595 TOWNLINE RD
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-2342
Country	:	US
Telephone Number	:	330-979-4045
Fax Number	:

Provider Business Practice Location Address
First Line	:	9826 WASHINGTON ST
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-5401
Country	:	US
Telephone Number	:	440-708-0188
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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