Provider Demographics
NPI:1861453607
Name:SCHEIDLER-SMITH, LARA (MA, CCC-SLP, HIS)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:SCHEIDLER-SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5468 HOLIDAY TERRACE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009
Mailing Address - Country:US
Mailing Address - Phone:269-815-6116
Mailing Address - Fax:336-725-0454
Practice Address - Street 1:5468 HOLIDAY TERRACE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-815-6116
Practice Address - Fax:336-725-0454
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3502013331237700000X
NC7066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC747485KMedicaid
NC7485KOtherNC BCBS