Provider Demographics
NPI:1073125944
Name:SCHROEDER, SHAUN
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:SCHROEDER
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 1:112 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:MARTELLE
Mailing Address - State:IA
Mailing Address - Zip Code:52305-7716
Mailing Address - Country:US
Mailing Address - Phone:319-480-7321
Mailing Address - Fax:
Practice Address - Street 1:112 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:MARTELLE
Practice Address - State:IA
Practice Address - Zip Code:52305-7716
Practice Address - Country:US
Practice Address - Phone:319-480-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health