Provider Demographics
NPI:1104840537
Name:SCHROEDER, DAVID CHARLES (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHARLES
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 EAGLE PARK DRIVE NE
Mailing Address - Street 2:STE 107
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2458
Mailing Address - Country:US
Mailing Address - Phone:616-666-9921
Mailing Address - Fax:866-222-8422
Practice Address - Street 1:3355 EAGLE PARK DR NE
Practice Address - Street 2:STE 107
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7004
Practice Address - Country:US
Practice Address - Phone:616-666-9921
Practice Address - Fax:866-222-8422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010978061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209511Medicare ID - Type UnspecifiedLCSW