1649399718 NPI number — MRS. MARISSA M. SCHMIDT-POWELL M.A. CCC-SLP

Table of content: MRS. MARISSA M. SCHMIDT-POWELL M.A. CCC-SLP (NPI 1649399718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649399718 NPI number — MRS. MARISSA M. SCHMIDT-POWELL M.A. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDT-POWELL
Provider First Name:
MARISSA
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649399718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5763
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97304-0763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-508-1600
Provider Business Mailing Address Fax Number:
503-304-0856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2262 BANYONWOOD AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97304-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-508-1600
Provider Business Practice Location Address Fax Number:
503-304-0856
Provider Enumeration Date:
03/28/2007

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: 235Z00000X , with the licence number:  11603 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205471 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11603 . This is a "OREGON LICENSE NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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