Basic Information
| Provider Information | |||||||||
| NPI: | 1376965640 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHMIDT SPEECH LANGUAGE PATHOLOGY SERVICES LLC | ||||||||
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| OtherOrganizationName: | THERAPY WORKS OF NEBRASKA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3925 S 147TH ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681445576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029421329 | ||||||||
| FaxNumber: | 4026064664 | ||||||||
| Practice Location | |||||||||
| Address1: | 3925 S 147TH ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681445576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029421329 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2014 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | PRANGE | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | HINMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3038157527 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | 1361 | NE | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 10026342900 | 05 | NE | MEDICAID |