Provider Demographics
NPI:1134665342
Name:SCHROEDER, JACOB ISAAC (PLMHP)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ISAAC
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5847 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1856
Mailing Address - Country:US
Mailing Address - Phone:402-571-7148
Mailing Address - Fax:402-571-7289
Practice Address - Street 1:5847 N 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1856
Practice Address - Country:US
Practice Address - Phone:402-571-7148
Practice Address - Fax:402-571-7289
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11099101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)