Provider Demographics
NPI:1205922754
Name:SCHMIDT, MARY KATHERINE (MA RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MA RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6110 NORTH PORT WASHINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-332-2074
Mailing Address - Fax:414-332-2583
Practice Address - Street 1:6110 NORTH PORT WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-332-2074
Practice Address - Fax:414-332-2583
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILPC 1769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health