Provider Demographics
NPI:1043431059
Name:SCHMADER, KIMBERLY LYNN (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:SCHMADER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1685 RATTLESNAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15823
Mailing Address - Country:US
Mailing Address - Phone:814-265-8209
Mailing Address - Fax:
Practice Address - Street 1:110 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-887-5591
Practice Address - Fax:814-887-5666
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003919L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018797330002Medicaid