MEDICARE: JESSICA SCHMIDT MSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487100343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SCHMIDT MSW

Provider Business Mailing Address
First Line	:	1900 SILVER LAKE ROAD, SUITE
Second Line	:	NYSTROM & ASSOCIATES, LTD.
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9998
Country	:	US
Telephone Number	:	651-628-9566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 SILVER LAKE ROAD, SUITE
Second Line	:	NYSTROM & ASSOCIATES, LTD.
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9998
Country	:	US
Telephone Number	:	651-628-9566
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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