1679037030 NPI number — MRS. CAMI MARIE SCHMIDTKE MS, BCBA

Table of content: MRS. CAMI MARIE SCHMIDTKE MS, BCBA (NPI 1679037030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679037030 NPI number — MRS. CAMI MARIE SCHMIDTKE MS, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDTKE
Provider First Name:
CAMI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEARCY
Provider Other First Name:
CAMI
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679037030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5729 HEMLOCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70605-8125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-914-6092
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 WILLIAMSBURG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70605-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-377-6206
Provider Business Practice Location Address Fax Number:
866-399-7694
Provider Enumeration Date:
01/29/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-19-35807 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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