Provider Demographics
NPI:1144390741
Name:SCHROEDER-MILLER, BRENDA JEAN (CCMT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JEAN
Last Name:SCHROEDER-MILLER
Suffix:
Gender:F
Credentials:CCMT
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:JEAN
Other - Last Name:DRESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 19TH AVE SW
Mailing Address - Street 2:LAKE REGION MASSAGE & BODYWORKS
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5297
Mailing Address - Country:US
Mailing Address - Phone:320-222-1521
Mailing Address - Fax:
Practice Address - Street 1:412 19TH AVE SW
Practice Address - Street 2:LAKE REGION MASSAGE & BODYWORKS
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5297
Practice Address - Country:US
Practice Address - Phone:320-222-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNONE NEEDED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist