Provider Demographics
NPI:1124223193
Name:SCHROEDER, ELAINE DIANE (MSW PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:DIANE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MSW PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 WILLOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-586-6879
Mailing Address - Fax:907-586-6879
Practice Address - Street 1:1706 WILLOW DRIVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-586-6879
Practice Address - Fax:907-586-6879
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK25104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker