Provider Demographics
NPI:1972558153
Name:SCHNELL, GLORIA M (AUD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:SCHNELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W IRONWOOD DR
Mailing Address - Street 2:SUITE 236
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4484
Mailing Address - Country:US
Mailing Address - Phone:208-765-1345
Mailing Address - Fax:208-667-9622
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:SUITE 236
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4484
Practice Address - Country:US
Practice Address - Phone:208-765-1345
Practice Address - Fax:208-667-9622
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20618231H00000X
MT1171231H00000X
IDAUD1832231H00000X, 237700000X
OR0309167354237700000X
MT382237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132070Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
ID1581407Medicare PIN