Provider Demographics
NPI:1144708587
Name:SCHMID, JENNIFER (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SCHMID
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-9602
Practice Address - Country:US
Practice Address - Phone:540-832-9012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-28
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000096235Z00000X
VA2202009315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist