Provider Demographics
NPI:1114513322
Name:SCHRADER, WANDA IVELISSE (ICADC, CADAC II)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:IVELISSE
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:ICADC, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18425 PONY EXPRESS DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9605
Mailing Address - Country:US
Mailing Address - Phone:303-805-1218
Mailing Address - Fax:
Practice Address - Street 1:18425 PONY EXPRESS DR UNIT 203
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9605
Practice Address - Country:US
Practice Address - Phone:303-805-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)