Provider Demographics
NPI:1215761705
Name:SCHMECHEL, CONRAD WILKINSON
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:WILKINSON
Last Name:SCHMECHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 LESMER CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-1205
Mailing Address - Country:US
Mailing Address - Phone:206-802-8690
Mailing Address - Fax:
Practice Address - Street 1:227 BLUE EARTH PL APT 203C
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6647
Practice Address - Country:US
Practice Address - Phone:206-802-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03638-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist