Provider Demographics
NPI:1043374077
Name:SCHMIDT, SUSAN R (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4701
Mailing Address - Country:US
Mailing Address - Phone:602-265-9000
Mailing Address - Fax:602-528-1900
Practice Address - Street 1:4004 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4701
Practice Address - Country:US
Practice Address - Phone:602-265-9000
Practice Address - Fax:602-528-1900
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA2001231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS760000OtherAHCCCS
AZP92497Medicare UPIN
AZ104544Medicare ID - Type Unspecified