Provider Demographics
NPI:1588169536
Name:SCHAMP, MIKAELA ANNE
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:ANNE
Last Name:SCHAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAELA
Other - Middle Name:
Other - Last Name:SCHAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6245 SW ARBOR GROVE DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3969
Mailing Address - Country:US
Mailing Address - Phone:541-760-5901
Mailing Address - Fax:
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health