Provider Demographics
NPI:1992438493
Name:SCHAKETT, MAUREEN
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:SCHAKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 PERCHA PL SE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8003
Mailing Address - Country:US
Mailing Address - Phone:405-919-0309
Mailing Address - Fax:
Practice Address - Street 1:4041 PERCHA PL SE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NC
Practice Address - Zip Code:28461-8003
Practice Address - Country:US
Practice Address - Phone:405-919-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006724235Z00000X
NC15382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006724OtherCONNECTICUT DEPARTMENT OF HEALTH