1861453607 NPI number — MRS. LARA SCHEIDLER-SMITH MA, CCC-SLP, HIS

Table of content: GRACE ABAD MSN RN, ANP-BC (NPI 1710203450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861453607 NPI number — MRS. LARA SCHEIDLER-SMITH MA, CCC-SLP, HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHEIDLER-SMITH
Provider First Name:
LARA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP, HIS
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:
1861453607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5468 HOLIDAY TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-815-6116
Provider Business Mailing Address Fax Number:
336-725-0454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5468 HOLIDAY TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-815-6116
Provider Business Practice Location Address Fax Number:
336-725-0454
Provider Enumeration Date:
03/31/2006

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: 237700000X , with the licence number:  3502013331 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 7066 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 747485K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7485K . This is a "NC BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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