MEDICARE: MRS. DOREEN ANN SCHAETZ MA,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	293783-4102	UT

General Provider Information

NPI Number	:	1629243274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOREEN ANN SCHAETZ MA,CCC-SLP

Provider Business Mailing Address
First Line	:	5435 PIONEER FORK RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1675
Country	:	US
Telephone Number	:	801-583-6103
Fax Number	:	801-583-6103

Provider Business Practice Location Address
First Line	:	5435 PIONEER FORK RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1675
Country	:	US
Telephone Number	:	801-583-6103
Fax Number	:	801-583-6103

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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