Provider Demographics
NPI:1881578003
Name:SCHMIDT, DEBORAH LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEB
Other - Middle Name:LYNN
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:10000 HWY 55 STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6433
Mailing Address - Country:US
Mailing Address - Phone:612-217-2019
Mailing Address - Fax:
Practice Address - Street 1:10000 HWY 55 STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6433
Practice Address - Country:US
Practice Address - Phone:612-217-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN217761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical